title: Real-time myocardial contrast dobutamine stress echocardiography in coronary stenosis.
abstract: BACKGROUND
  Simultaneous wall motion and myocardial perfusion analysis could offer advantages over either method alone. Diagnostic utility of combining these parameters during dobutamine stress echocardiography is evaluated in this study.
  
  
  METHODS
  Myocardial contrast dobutamine stress echocardiography was performed on thirty-eight patients with single or double vessel coronary artery stenosis of >50%. Two-dimensional standard wall motion images were acquired at baseline, low, intermediate and peak stages of dobutamine stress echocardiography. Contrast enhanced wall motion and perfusion were assessed with Cadence Contrast Imaging (Sequoia C256, Acuson) and Optison infusion (GE Healthcare) at baseline and peak stages of the same protocol. Perfusion was analysed by identification of contrast defects and by measuring contrast replenishment time after destructive ultrasound pulses.
  
  
  RESULTS
  The group consisted of 28 males and 10 females, mean age 60.9+/-9.7 years. Fifty-four out of one hundred and fourteen coronary arteries were affected by stenoses >50%. Standard wall motion analysis was assessable in 37 cases, one of which was inconclusive, while contrast wall motion and perfusion were assessable in 32 cases. Accuracy for coronary stenosis was 84% for standard wall motion (108 coronary territories), 82% for contrast wall motion (96 territories), 69% for peak stress contrast defects (83 territories), 91% for combined peak stress contrast defects and increased contrast replenishment time (85 territories), and 90% for all contrast modalities combined (96 territories).
  
  
  CONCLUSIONS
  Combined wall motion and real-time perfusion assessment during dobutamine stress is feasible and at least equivalent to conventional stress echocardiography for detection of significant coronary stenosis.
authors.affiliation: Cardiology Department, Royal Free Hospital, London, United Kingdom. elvedroberts@hotmail.com
authors.forename: Elved B
authors.initials: EB
authors.lastname: Roberts
authors.forename: Frank
authors.initials: F
authors.lastname: Schafer
authors.forename: Wahid
authors.initials: W
authors.lastname: Akhtar
authors.forename: Devan
authors.initials: D
authors.lastname: Patel
authors.forename: Tom R
authors.initials: TR
authors.lastname: Evans
authors.forename: J G
authors.initials: JG
authors.lastname: Coghlan
authors.forename: David P
authors.initials: DP
authors.lastname: Lipkin
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Davar
mesh_terms: D000368:Aged; D016477:Artifacts; D002316:Cardiotonic Agents; D003199:Computer Systems; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004280:Dobutamine; D004452:Echocardiography; D025401:Echocardiography, Stress; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine