title: Prospective randomized comparison of conventional stress echocardiography and real-time perfusion stress echocardiography in detecting significant coronary artery disease.
abstract: BACKGROUND
  Although retrospective studies have suggested that myocardial perfusion and wall motion analysis with real-time myocardial contrast echocardiography (RTMCE) improves the detection of coronary artery disease (CAD) during dobutamine or exercise stress echocardiography, a prospective randomized comparison with conventional stress echocardiography that did not use RTMCE has not been performed.
  
  
  METHODS
  A total of 1,776 patients with preserved resting left ventricular wall motion undergoing dobutamine or exercise stress echocardiography for suspicion of CAD were randomized to either non-RTMCE, for which contrast was used only for the approved indication of enhancing left ventricular opacification, or RTMCE, for which contrast infusion was used in all cases to examine both wall motion and myocardial perfusion. Comparisons in test positivity, and positive predictive value in those subsequently referred for quantitative coronary angiography, were performed.
  
  
  RESULTS
  Patients randomized to RTMCE had significantly higher test positivity (22% for RTMCE vs 15% with non-RTMCE, P = .0002). The increased test positivity occurred without a difference in positive predictive value in predicting >50% diameter stenoses by quantitative coronary angiography (67% for non-RTMCE, 73% for RTMCE). The mechanism for increased detection of CAD with RTMCE was mostly due to the detection of subendocardial wall thickening abnormalities that would have gone undetected when examining transmural wall thickening.
  
  
  CONCLUSIONS
  RTMCE improves the detection of CAD during dobutamine and exercise stress echocardiography, mainly by the detection of subendocardial ischemia.
authors.affiliation: Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Thomas
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Smith
authors.forename: Edward
authors.initials: E
authors.lastname: O'Leary
authors.forename: Kara
authors.initials: K
authors.lastname: Smith
authors.forename: Joan
authors.initials: J
authors.lastname: Olson
authors.forename: Kevin
authors.initials: K
authors.lastname: Nalty
authors.forename: Roberta
authors.initials: R
authors.lastname: Hess
authors.forename: Michelle
authors.initials: M
authors.lastname: Graham
authors.forename: Stacey
authors.initials: S
authors.lastname: Therrien
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D003199:Computer Systems; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004280:Dobutamine