title: Impact of previous myocardial infarction on the incremental value of myocardial contrast to two-dimensional supine bicycle stress echocardiography in evaluation of coronary artery disease.
abstract: BACKGROUND
  If compared to two-dimensional echocardiography (2DE), myocardial contrast echocardiography (MCE) improves detection of coronary artery disease (CAD) during pharmacological stress, but data on MCE vs. 2DE during supine bicycle stress is limited. Although previous myocardial infarction (MI) influences sensitivity of 2DE, its effect on MCE has not been evaluated.
  
  
  OBJECTIVE
  The study sought to determine the incremental benefit of MCE over 2DE for evaluation of CAD during supine bicycle stress and to assess the impact of previous MI on diagnostic values of both methods.
  
  
  METHODS
  We studied 103 consecutive patients scheduled for coronary angiography. Prior to coronary angiography, all patients underwent supine bicycle stress. 2DE and MCE were performed during this stress test. The diagnosis of obstructive CAD (> or =50% stenosis) was based on the presence of inducible wall motion and perfusion abnormalities.
  
  
  RESULTS
  Quantitative coronary angiography revealed > or =50% stenosis in 53 of 77 patients without previous MI and in 21 of 26 patients with previous MI. If compared to 2DE, MCE was more sensitive (68% vs. 86%; p<0.001) and more accurate (73% vs. 86%; p < 0.001) to detect > or =50% stenosis. In patients without previous MI, 2DE and MCE yielded sensitivity of 65% and 85% (p < 0.01) and accuracy of 71% and 85% (p < 0.01), whereas in patients with previous MI sensitivity was 79% and 90% (p=NS) and accuracy 79% and 88% (p = NS), respectively.
  
  
  CONCLUSIONS
  MCE enhances sensitivity and accuracy of 2DE in detection of obstructive CAD during supine bicycle stress. The incremental benefit of MCE is especially present in patients without previous MI.
authors.affiliation: Centre for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Kraków, Poland. miszalt@mp.pl
authors.forename: Tomasz
authors.initials: T
authors.lastname: Miszalski-Jamka
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kuntz-Hehner
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Karol
authors.initials: K
authors.lastname: Miszalski-Jamka
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiemann
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Clemens
authors.initials: C
authors.lastname: Troatz
authors.forename: Mieczysław
authors.initials: M
authors.lastname: Pasowicz
authors.forename: Berndt
authors.initials: B
authors.lastname: Lüderitz
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods* / Q000592:standards; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D016683:Supine Position