Diagnosis of ischaemic heart disease by myocardial contrast echocardiography during supine bicycle stress.
BACKGROUND
Myocardial contrast echocardiography (MCE) is a new imaging modality for diagnosing ischaemic heart disease (IHD).


OBJECTIVE
The aim of this study was to assess 1) the feasibility of MCE during supine bicycle stress and 2) the value of this method in the diagnosis of IHD.


METHODS
Supine bicycle stress was performed in 44 consecutive patients (pts) referred for coronary angiography with an intermediate pre-test probability of IHD. MCE was carried out at peak stress and during recovery (once the heart rate returned to the pre-exercise value). During MCE an ultrasound contrast agent (Sonovue) was administered intravenously in a continuous mode using an infusion pump (BR-INF 100, Bracco Research). The acquired images were qualitatively assessed for perfusion and wall motion abnormalities. The 18-segment division of the left ventricle was used in the analysis. Coronary angiography was performed in all pts within 15 days of the exercise test. A quantitative analysis of coronary artery stenoses was carried out using the CAAS system.


RESULTS
MCE could not be performed in 2 pts due to technical difficulties. Coronary angiography revealed significant coronary artery stenosis in 25 pts. The sensitivity and specificity of MCE in the diagnosis of IHD were 92.0% and 82.4%, respectively. The positive and negative predictive values were found to be 88.5% and 87.5%, respectively, while the agreement between coronary angiography and MCE was 88.1% (kappa=0.75).


CONCLUSIONS
MCE during supine bicycle stress and continuous intravenous administration of an ultrasound contrast agent is a feasible technique and allows accurate diagnosis of IHD in pts in whom the pre-test probability of the disease is intermediate.
Miszalski-Jamka
Tomasz
T
II Katedra Chorób Wewnetrznych, Collegium Medicum UJ, ul. Skawińska 8, 31-066 Kraków, Poland. miszalt@mp.pl
Kuntz-Hehner
Stefanie
S
Schmidt
Harald
H
Jost
Pischel
P
Luderitz
Berndt
B
Omran
Heyder
H
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D010743:Phospholipids; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D016683:Supine Position
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride