title: Real-time three-dimensional dobutamine stress echocardiography for coronary artery disease diagnosis: validation with coronary angiography.
abstract: OBJECTIVE
  To compare real-time three-dimensional echocardiography (RT3DE) with two-dimensional dobutamine stress echocardiography (2DE) for the detection of myocardial ischaemia, with angiographic validation of the results.
  
  
  METHODS
  56 patients (mean (SD) age 64.5 (6.2) years, 38 males), referred for coronary angiography, were examined by 2DE and RT3DE during the same dobutamine stress protocol.
  
  
  RESULTS
  All 56 patients completed the stress protocol uneventfully. The mean (SD) acquisition time for the necessary views to evaluate all segments was 26.3 (2.5) s for RT3DE and 58.8 (3.7) s for 2DE (p<0.001). At peak stress, RT3DE had a higher wall-motion score index (1.25 (0.24) by 2DE, 1.30 (0.27) by RT3DE; p = 0.014). The regional wall-motion score for the four apical segments at peak stress was compared; it was 1.35 (0.55) by 2DE and 1.52 (0.69) by RT3DE (p = 0.003). The diagnostic parameters of 2DE versus RT3DE were: sensitivity 73% vs 78%, specificity 93% vs 89% and overall accuracy 86% vs 85%, respectively. In the left anterior descending artery territory, in particular, where RT3DE had higher regional wall-motion scores, it showed a tendency towards higher sensitivity (85% vs 78%), although this difference did not achieve statistical significance.
  
  
  CONCLUSIONS
  RT3DE identifies wall-motion abnormalities more readily in the apical region than 2DE, which may explain the tendency towards higher sensitivity in the left anterior descending artery territory. RT3DE results were validated using angiography as reference and findings indicate diagnostic equivalence to 2DE, with the advantage of considerable shorter acquisition times.
authors.affiliation: 1st Cardiology Department, University of Athens School of Medicine, Hippokration Hospital, Athens, Greece. caggeli@hol.gr
authors.forename: Constadina
authors.initials: C
authors.lastname: Aggeli
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.forename: Platon
authors.initials: P
authors.lastname: Misovoulos
authors.forename: George
authors.initials: G
authors.lastname: Roussakis
authors.forename: Euaggelia
authors.initials: E
authors.lastname: Christoforatou
authors.forename: Christos
authors.initials: C
authors.lastname: Kokkinakis
authors.forename: Stela
authors.initials: S
authors.lastname: Brili
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D012680:Sensitivity and Specificity