Detection of coronary artery disease with a continuous infusion of definity ultrasound contrast during adenosine stress real time perfusion echocardiography.
BACKGROUND
Myocardial perfusion imaging during adenosine stress is an accurate method of detecting physiologically relevant coronary artery disease.


METHODS
Real time perfusion echocardiography (RTPE) was compared to nuclear scintigraphy (rest Thallium, stress Sestamibi) in 40 patients with intermediate to high pretest probability. RTPE was performed with a continuous infusion of intravenous microbubbles (Definity; Bristol Myers Squibb) and intermittent high mechanical index impulses, with visual examination of both the replenishment rate and plateau intensity of contrast.


RESULTS
Of the 119 coronary artery territories compared, SPECT and RTPE were in agreement in 105 (88% agreement; kappa 0.67). In patients who went on to quantitative coronary arteriography (QCA), there were three who had normal appearing radionuclide SPECT during adenosine, but subendocardial perfusion defects with RTPE. In all three cases, QCA confirmed the presence of a >50% diameter stenosis in the abnormal territory.


CONCLUSIONS
We conclude from this study that adenosine stress imaging with RTPE is an accurate method of detecting coronary artery disease. The higher resolution of RTPE may identify subendocardial defects that would otherwise have gone undetected with radionuclide imaging.
Xie
Feng
F
University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska 68198-2265, USA.
Hankins
Jordan
J
Mahrous
Heidi A
HA
Porter
Thomas R
TR
D000241:Adenosine / Q000008:administration & dosage; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014665:Vasodilator Agents / Q000008:administration & dosage
D005466:Fluorocarbons; D014665:Vasodilator Agents; D000241:Adenosine; C042852:perflutren