title: Real-time myocardial perfusion imaging for pharmacologic stress testing: added value to single photon emission computed tomography.
abstract: 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.
authors.affiliation: Department of Cardiology, University of Heidelberg, Heidelberg, Germany. grigorios_korosoglou@med.uni-heidelberg.de
authors.forename: Grigorios
authors.initials: G
authors.lastname: Korosoglou
authors.forename: Alain-Eric
authors.initials: AE
authors.lastname: Dubart
authors.forename: K Gaspar C
authors.initials: KG
authors.lastname: DaSilva
authors.forename: Nino
authors.initials: N
authors.lastname: Labadze
authors.forename: Stefan
authors.initials: S
authors.lastname: Hardt
authors.forename: Alexander
authors.initials: A
authors.lastname: Hansen
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
authors.forename: Christian
authors.initials: C
authors.lastname: Zugck
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehelein
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Helmut
authors.initials: H
authors.lastname: Kuecherer
mesh_terms: 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
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi