Accelerated stress real-time myocardial contrast echocardiography for the detection of coronary artery disease: comparison with 99mTc single photon emission computed tomography.
OBJECTIVE
The aims of this prospective study were to compare the diagnostic value of accelerated vasodilator stress real-time myocardial contrast echocardiography (MCE) and single photon emission computed tomography (SPECT) against coronary angiography and to evaluate whether the addition of MCE perfusion data improves the diagnostic accuracy of stress echocardiography.


METHODS
A total of 103 patients with suspected or known stable coronary artery disease (CAD) underwent SPECT and accelerated high-dose dipyridamole (0.84 mg/kg intravenously for 4 minutes) atropine (up to 1 mg intravenously) stress real-time qualitative MCE. The presence of CAD was detected by coronary angiography.


RESULTS
CAD defined as >or= 70% stenosis was detected in 77% of patients, whereas 86% of patients had CAD defined as >or= 50% stenosis. In a territory-by-territory analysis, the concordance between MCE and SPECT in detecting perfusion defects varied from 72.8% (kappa = 0.386) to 89.3% (kappa = 0.642). There were no significant differences between MCE and SPECT in sensitivity, specificity, and diagnostic accuracy for identifying patients with CAD. Combining MCE and wall motion abnormality analysis significantly improved the sensitivity of the test compared with wall motion abnormality analysis alone.


CONCLUSIONS
Accelerated vasodilator stress real-time MCE yields a good concordance with SPECT in detection of perfusion defects and a similar diagnostic value for the detection of CAD. The addition of MCE perfusion data improves the diagnostic value of stress echocardiography.
Lipiec
Piotr
P
Second Department of Cardiology, Medical University of Łódź, Poland. lipiec@ptkardio.pl
Wejner-Mik
Paulina
P
Krzemińska-Pakuła
Maria
M
Kuśmierek
Jacek
J
Płachcińska
Anna
A
Szumiński
Remigiusz
R
Peruga
Jan Z
JZ
Kasprzak
Jarosław D
JD
D000328:Adult; D000368:Aged; D000418:Albumins; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons; D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D017256:Technetium Tc 99m Sestamibi