Real-time myocardial perfusion imaging for pharmacologic stress testing: added value to single photon emission computed tomography.
BACKGROUND
Little is known about the incremental value of real-time myocardial contrast echocardiography (MCE) as an adjunct to pharmacologic stress testing. This study was performed to evaluate the diagnostic value of MCE to detect abnormal myocardial perfusion by technetium Tc 99m sestamibi-single photon emission computed tomography (SPECT) and anatomically significant coronary artery disease (CAD) by angiography.


METHODS
Myocardial contrast echocardiography was performed at rest and during vasodilator stress in consecutive patients (N = 120) undergoing SPECT imaging for known or suspected CAD. Myocardial opacification, wall motion, and tracer uptake were visually analyzed in 12 myocardial segments by 2 pairs of blinded observers. Concordance between the 2 methods was assessed using the kappa statistic.


RESULTS
Of 1356 segments, 1025 (76%) were interpretable by MCE, wall motion, and SPECT. Sensitivity of wall motion was 75%, specificity 83%, and accuracy 81% for detecting abnormal myocardial perfusion by SPECT (kappa = 0.53). Myocardial contrast echocardiography and wall motion together yielded significantly higher sensitivity (85% vs 74%, P < .05), specificity of 83%, and accuracy of 85% (kappa = 0.64) for the detection of abnormal myocardial perfusion. In 89 patients who underwent coronary angiography, MCE and wall motion together yielded higher sensitivity (83% vs 64%, P < .05) and accuracy (77% vs 68%, P < .05) but similar specificity (72%) compared with SPECT for the detection of high-grade, stenotic (> or = 75%) coronary lesions.


CONCLUSIONS
Assessment of myocardial perfusion adds value to conventional stress echocardiography by increasing its sensitivity for the detection of functionally abnormal myocardial perfusion. Myocardial contrast echocardiography and wall motion together provide higher sensitivity and accuracy for detection of CAD compared with SPECT.
Korosoglou
Grigorios
G
Department of Cardiology, University of Heidelberg, Heidelberg, Germany. grigorios_korosoglou@med.uni-heidelberg.de
Dubart
Alain-Eric
AE
DaSilva
K Gaspar C
KG
Labadze
Nino
N
Hardt
Stefan
S
Hansen
Alexander
A
Bekeredjian
Raffi
R
Zugck
Christian
C
Zehelein
Joerg
J
Katus
Hugo A
HA
Kuecherer
Helmut
H
D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi