Myocardial contrast echocardiography in assessment of stable coronary artery disease at intermediate dobutamine-induced stress level.
BACKGROUND
Myocardial contrast stress echocardiography (stress MCE) is a novel method for diagnosing coronary artery disease (CAD). Few studies have compared the diagnosis of ischemia by stress MCE to angiographic CAD.


METHODS
Dobutamine stress MCE and SonoVue contrast infusion were performed before an elective percutaneous coronary intervention in 37 patients (8 women) aged 45-75 years with symptomatic CAD and at least one significant coronary artery stenosis measured by quantitative coronary angiography (QCA). The total and regional perfusion and wall motion (WM) were scored as normal or abnormal and attributed to the three main epicardial coronary arteries using a 17-segment left ventricular model.


RESULTS
An intermediate stress level was obtained in 29 (78%) patients, and 2 (5%) patients obtained peak stress. A perfusion defect was detected in 92% and WM abnormality in 57% of the patients at peak stress (P < 0.01). By perfusion, 70% of stenoses were both detected and correctly anatomically located, compared to 42% by WM (P < 0.01). All 21 patients with multivessel disease and/or proximal left anterior descending (LAD) stenosis measured by QCA were identified by stress-induced perfusion defects, while only 11 of them were identified by WM abnormalities (P < 0.01).


CONCLUSIONS
Perfusion scoring is superior to WM scoring during stress MCE for diagnosing significant CAD in patients obtaining intermediate stress level, in particular, when multivessel disease or proximal LAD stenosis is present.
Lønnebakken
Mai Tone
MT
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. mai.tone.lonnebakken@helsebergen.no
Bleie
Oyvind
O
Strand
Elin
E
Staal
Eva M
EM
Nygård
Ottar K
OK
Gerdts
Eva
E
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000368:Aged; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000494:pharmacology*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013312:Stress, Physiological / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D003287:Contrast Media; D004280:Dobutamine