Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease.
OBJECTIVE
This study sought to compare the accuracy of myocardial contrast echocardiography (MCE) and wall motion analysis (WMA) during submaximal and peak dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD).


BACKGROUND
The relative merits of MCE and WMA for the detection of CAD during DSE have not been studied in a large number of patients.


METHODS
We studied 170 patients who underwent dobutamine (up to 50 microg/kg/min)-atropine stress testing and coronary angiography. The WMA and MCE (using repeated boluses of Optison [Mallinckrodt, St. Louis, Missouri] or Definity [Bristol-Myers Squibb, New York, New York]) were performed at rest, at intermediate stress (65% to 75% of maximal heart rate), and at peak stress. The diagnosis of CAD (>/=50% stenosis in >/=1 coronary artery) was based on reversible wall motion and perfusion abnormalities.


RESULTS
Coronary artery disease was detected in 127 (75%) patients. Sensitivity of MCE was higher than that of WMA at maximal stress (91% vs. 70%; p = 0.001) and at intermediate stress (84% vs. 20%; p = 0.0001). Specificity was lower for MCE compared with WMA (51% vs. 74%; p = 0.01). Overall accuracy was higher for MCE than for WMA (81% vs. 71%; p = 0.01). Sensitivity for detection of CAD based on abnormalities in >/=2 vascular regions was higher for MCE than for WMA (67% vs. 28%; p < 0.01).


CONCLUSIONS
The majority of inducible perfusion abnormalities occur at an intermediate phase of the stress test, without wall motion abnormalities. Myocardial contrast echocardiography provides better sensitivity than WMA, particularly in patients with submaximal stress and in identifying patients with multivessel CAD.
Elhendy
Abdou
A
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
O'Leary
Edward L
EL
Xie
Feng
F
McGrain
Anna C
AC
Anderson
James R
JR
Porter
Thomas R
TR
D000368:Aged; D000418:Albumins; D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D025401:Echocardiography, Stress; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons