title: Head to head comparisons of two modalities of perfusion adenosine stress echocardiography with simultaneous SPECT.
abstract: BACKGROUND
  Real-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia. We compared two different types of RTP power modulation techniques, angiomode (AM) and high-resolution grayscale (HR), with 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia.
  
  
  METHODS
  Patients with known or suspected coronary artery disease (CAD), admitted to SPECT, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using AM and HR during Sonovue(R) infusion, before and throughout the adenosine stress, also used for SPECT. Analysis of myocardial perfusion and wall motion by RTP-ASE were done for AM and HR at different time points, blinded to one another and to SPECT. Each segment was attributed to one of the three main coronary vessel areas of interest.
  
  
  RESULTS
  In 50 patients, 150 coronary areas were analyzed by SPECT and RTP-ASE AM and HR. SPECT showed evidence of ischemia in 13 out of 50 patients. There was no significant difference between AM and HR in detecting ischemia (p = 0.08). The agreement for AM and HR, compared to SPECT, was 93% and 96%, with Kappa values of 0.67 and 0.75, respectively (p < 0.001).
  
  
  CONCLUSIONS
  There was no significant difference between AM and HR in correctly detecting myocardial ischemia as judged by SPECT. This suggests that different types of RTP modalities give comparable data during RTP-ASE in patients with known or suspected CAD.
authors.affiliation: Department of Clinical Physiology, Lund University, Malmö University Hospital, Malmö, Sweden. petri.gudmundsson@mah.se
authors.forename: Petri
authors.initials: P
authors.lastname: Gudmundsson
authors.forename: Kambiz
authors.initials: K
authors.lastname: Shahgaldi
authors.forename: Reidar
authors.initials: R
authors.lastname: Winter
authors.forename: Magnus
authors.initials: M
authors.lastname: Dencker
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kitlinski
authors.forename: Ola
authors.initials: O
authors.lastname: Thorsson
authors.forename: Lennart
authors.initials: L
authors.lastname: Ljunggren
authors.forename: Ronnie B
authors.initials: RB
authors.lastname: Willenheimer
mesh_terms: D000241:Adenosine; D000368:Aged; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000592:standards
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D000241:Adenosine