title: The diagnostic value of adenosine stress-contrast echocardiography for diagnosis of coronary artery disease in hypertensive patients: comparison to Tl-201 single-photon emission computed tomography.
abstract: BACKGROUND
  The use of the vasodilating agent adenosine as stressor in conjunction with myocardial contrast echocardiography has not been extensively evaluated in hypertensive patients. Our aim was to evaluate the diagnostic value of adenosine myocardial contrast echocardiography (MCE) in comparison to single-photon emission computed tomography (SPECT), with reference to angiographic findings, in a hypertensive population.
  
  
  METHODS
  Fifty hypertensive subjects, treated with standard antihypertensive treatment, were submitted to adenosine stress MCE, adenosine SPECT, and coronary angiography within a 1-month period, without any intervening events.
  
  
  RESULTS
  Sensitivity, specificity, and accuracy were 88%, 89%, 88% for MCE and 80%, 94%, 85% for SPECT, respectively (P = not significant). In the analysis by coronary territory, it appears that MCE and SPECT are both more accurate in detecting lesions of the anterior than of the posterior coronary system, as suggested by the good concordance to angiography results in the left anterior descending artery territory (k = 0.640 and 0.671, respectively). Agreement with angiographic findings was moderate for the right coronary artery (k = 0.561 and 0.539, respectively), whereas left circumflex artery lesions were more accurately detected by MCE than by SPECT (k = 0.533 and 0.400, respectively), that is, MCE appears to be superior in the left circumflex artery territory.
  
  
  CONCLUSIONS
  In hypertensive patients, adenosine MCE has similar overall diagnostic accuracy with SPECT for assessment of coronary artery disease but is superior in the left circumflex artery territory.
authors.affiliation: 1st Cardiology Department, School of Medicine, University of Athens, Hippokration Hospital, Athens, Greece. caggeli@hol.gr
authors.forename: Constadina
authors.initials: C
authors.lastname: Aggeli
authors.forename: Euaggelia
authors.initials: E
authors.lastname: Christoforatou
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Roussakis
authors.forename: Christos
authors.initials: C
authors.lastname: Kokkinakis
authors.forename: John
authors.initials: J
authors.lastname: Barbetseas
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D009206:Myocardium; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D000241:Adenosine