title: Incremental value of perfusion over wall-motion abnormalities with the use of dobutamine-atropine stress myocardial contrast echocardiography and magnetic resonance imaging for detecting coronary artery disease.
abstract: BACKGROUND
  Recently, multimodality imaging has been demonstrated to improve the sensitivity of dobutamine stress for the diagnosis of coronary artery disease (CAD).
  
  
  OBJECTIVE
  We sought to determine the additional value of myocardial perfusion (MP) over wall-motion (WM) analysis for detecting CAD, using real time myocardial contrast echocardiography (RTMCE) and cardiovascular magnetic resonance (CMR), in the same group of patients.
  
  
  METHODS
  We studied 42 patients who underwent RTMCE and CMR during high-dose dobutamine stress with early injection of atropine.
  
  
  RESULTS
  No difference was observed in the diagnostic accuracy of RTMCE and CMR for detecting angiographically significant CAD when considering WM analysis alone (73% [95% CI, 65-81] and 78% [95% CI, 70-84], respectively; P = NS) or combined analysis of WM and MP (80% [95% CI, 73-97] and 83% [95% CI, 77-90], respectively; P = NS). Combined analysis of WM and MP had higher sensitivity than the analysis of WM alone by RTMCE (88% [95% CI, 75-100] vs. 72% [95% CI, 54-90]) and by CMR (92% [95% CI, 81-100] vs. 80% [95% CI, 64-96]) with no differences in specificity. The association of abnormal WM and MP abnormalities during high-dose dobutamine-atropine stress had additional value for detecting CAD over the analysis of WM alone, both by RTMCE (χ(2) = 16.16-24.13; P = 0.005) and CMR (χ(2) = 12.73-27.41; P = 0.001).
  
  
  CONCLUSIONS
  RTMCE and CMR using the same dobutamine-atropine stress protocol had comparable diagnostic accuracies for the detection of angiographically significant CAD. MP imaging had additional value over WM analysis for the diagnosis of CAD, both at RTMCE and CMR.
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Sandra Nivea dos Reis Saraiva
authors.initials: SN
authors.lastname: Falcão
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Wilson Mathias
authors.initials: WM
authors.lastname: Junior
authors.forename: Luiz
authors.initials: L
authors.lastname: Quaglia
authors.forename: Pedro Alves
authors.initials: PA
authors.lastname: Lemos
authors.forename: João César Nunes
authors.initials: JC
authors.lastname: Sbano
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
authors.forename: Jeane Mike
authors.initials: JM
authors.lastname: Tsutsui
mesh_terms: D001285:Atropine; D002316:Cardiotonic Agents; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique
chemical_list: D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine; D001285:Atropine