Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography.
BACKGROUND
We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI) for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE).Wall motion (WM) assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD), particularly in patients with isolated intermediate (50%-70%) coronary stenosis.


METHODS
We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography.


CONCLUSIONS
When CAD was defined as the presence of a >or=50% stenosis, the addition of MPI increased sensitivity (+30%) and decreased specificity (-14%), with a final increase in total diagnostic accuracy (+16%, p < 0.001). The addition of MPI data substantially increased the sensitivity to detect patients with isolated intermediate stenosis from 37% to 98% (p < 0.001); the incremental sensitivity was much lower in patients with severe stenosis, from 85% to 96% (p < 0.05), at the expense of a higher decrease in specificity and a final decrease in total diagnostic accuracy (-18%, p < 0.001).


CONCLUSIONS
The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (>or=50% or > 70% stenosis), but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis).The total diagnostic accuracy increased only when defining CAD as >or=50% stenosis, since in patients with severe stenosis (> 70%) the decrease in specificity is not counterbalanced by the minor sensitivity increase.
Gaibazzi
Nicola
N
Cardiology Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
Rigo
Fausto
F
Squeri
Angelo
A
Ugo
Fabrizio
F
Reverberi
Claudio
C
D000368:Aged; D001285:Atropine; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis; D023921:Coronary Stenosis / Q000175:diagnosis*; D004176:Dipyridamole; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging; D015588:Observer Variation; D012680:Sensitivity and Specificity
D003287:Contrast Media; D004176:Dipyridamole; D001285:Atropine
J Am Soc Echocardiogr. 2009 Apr;22(4):404-10
19345309
Circulation. 1999 Feb 16;99(6):763-70
9989961
J Am Soc Echocardiogr. 2008 Aug;21(8):941-7
18385014
J Am Coll Cardiol. 2004 Jan 21;43(2):257-64
14736446
J Am Coll Cardiol. 2006 Jan 3;47(1):141-5
16386678
J Am Coll Cardiol. 2009 Oct 27;54(18):e9
19850203
Am J Cardiol. 2007 Nov 15;100(10):1527-31
17996513
J Am Coll Cardiol. 2004 Dec 7;44(11):2185-91
15582317
J Am Coll Cardiol. 2005 Aug 2;46(3):438-42
16053955
J Am Soc Echocardiogr. 2009 Aug;22(8):954-60
19553084
J Am Coll Cardiol. 2005 Apr 19;45(8):1235-42
15837255
Circulation. 2005 Sep 6;112(10):1444-50
16129798
Circulation. 2004 Aug 31;110(9):1108-13
15326066
Eur Heart J. 2008 Oct;29(20):2536-43
18499651
Circulation. 2001 May 29;103(21):2560-5
11382724
Am J Cardiol. 2009 Mar 1;103(5):626-31
19231324
Eur J Echocardiogr. 2008 Jul;9(4):415-37
18579481
Eur Heart J. 2005 Oct;26(20):2136-41
16014645