title: The value of quantitative real-time myocardial contrast echocardiography for detection of angiographically significant coronary artery disease.
abstract: BACKGROUND
  Real-time (RT) myocardial contrast echocardiography (MCE) is a novel method for the assessment of regional myocardial perfusion. We sought to evaluate the feasibility and diagnostic accuracy of quantitative RT-MCE in predicting significant coronary stenosis, with reference to quantitative coronary angiography.
  
  
  OBJECTIVE
  RT-MCE can identify anatomically significant coronary artery stenosis in selected patients. RT-MCE is probably an effective method for detection of angiographically significant coronary artery stenosis.
  
  
  METHODS
  Thirty-five patients (mean age, 59.94 ± 10.63 years; 25 males) scheduled for coronary angiography underwent RT-MCE at rest, and shortly afterward underwent gated single-photon emission computed tomography (gated-SPECT). Coronary angiography was performed within 1 week after RT-MCE in all patients. The observing indexes included the images of RT-MCE that were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the Q-Lab software. The sensitivity and specificity of RT-MCE for quantitative detection of coronary artery disease (CAD) were obtained. The receiver operator characteristic (ROC) curves were used to assess the differences of accuracy in ischemic segments with A, β and A × β respectively. The sensitivity and specificity of gated-SPECT and RT-MCE for assessment of CAD were calculated using a 4-score method.
  
  
  RESULTS
  A total of 513 segments among 595 segments in 35 patients were obtained. The cutoffs for A, β and A × β were 4.58, 0.64, and 2.73, and the sensitivity and specificity of quantitative RT-MCE for detection of CAD were 86.0%, 80.2%, 88.9%, and 84.1%, 64.6%, 79.9%, respectively. Meanwhile, the sensitivity and specificity of semiquantitative analysis for assessment of CAD were 66.7% and 61.8%. The ROC curve area of A and A × β was 0.91 and 0.90 in the middle segments. The ROC area of A was 0.52 in the base segments. The sensitivity and specificity of gated-SPECT for assessment of CAD were 84.8% and 82.7%, respectively. The sensitivity of multi-indexes RT-MCE increased. The sensitivity was 89.1%, 90.4%, and 96.3% by A + β, A + A × β, and β + A × β.
  
  
  CONCLUSIONS
  Quantitative RT-MCE is an effective method for the detection of coronary artery stenosis. Quantitative RT-MCE is segmented for assessment to ischemic myocardium. RT-MCE with multi-indexes has a valuable application for assessment of CAD surpassing SPECT.
authors.affiliation: Cardiovascular Disease Institute of Xuzhou Medical College, Xuzhou, China.
authors.forename: Dong-ye
authors.initials: DY
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.forename: Tong-da
authors.initials: TD
authors.lastname: Xu
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: De-feng
authors.initials: DF
authors.lastname: Pan
authors.forename: Jun-hong
authors.initials: JH
authors.lastname: Chen
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Wang
mesh_terms: D000368:Aged; D019540:Area Under Curve; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D003287:Contrast Media; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010743:Phospholipids; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D013459:Sulfur Hexafluoride; D013997:Time Factors
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride