title: Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease: a large European multicenter study.
abstract: OBJECTIVE
  The purpose of this study was to compare sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) relative to coronary angiography (CA) for assessment of coronary artery disease (CAD).
  
  
  BACKGROUND
  Small-scale studies have shown that myocardial perfusion assessed by SonoVue-enhanced MCE is a viable alternative to SPECT for CAD assessment. However, large multicenter studies are lacking.
  
  
  METHODS
  Patients referred for myocardial ischemia testing at 34 centers underwent rest/vasodilator SonoVue-enhanced flash-replenishment MCE, standard (99m)Tc-labeled electrocardiography-gated SPECT, and quantitative CA within 1 month. Myocardial ischemia assessments by 3 independent, blinded readers for MCE and 3 readers for SPECT were collapsed into 1 diagnosis per patient per technique and were compared to CA (reference standard) read by 1 independent blinded reader.
  
  
  RESULTS
  Of 628 enrolled patients who received SonoVue (71% males; mean age: 64 years; >1 cardiovascular [CV] risk factor in 99% of patients) 516 patients underwent all 3 examinations, of whom 161 (31.2%) had ≥70% stenosis (131 had single-vessel disease [SVD]; 30 had multivessel disease), and 310 (60.1%) had ≥50% stenosis. Higher sensitivity was obtained with MCE than with SPECT (75.2% vs. 49.1%, respectively; p < 0.0001), although specificity was lower (52.4% vs. 80.6%, respectively; p < 0.0001) for ≥70% stenosis. Similar findings were obtained for patients with ≥50% stenosis. Sensitivity levels for detection of SVD and proximal disease for ≥70% stenosis were higher for MCE (72.5% vs. 42.7%, respectively; p < 0.0001; 80% vs. 58%, respectively; p = 0.005, respectively).
  
  
  CONCLUSIONS
  SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue® enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).
authors.affiliation: Department of Cardiology, Royal Brompton Hospital and Northwick Park Hospital, London, Harrow, United Kingdom. Electronic address: roxysenior@cardiac-research.org.
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
authors.forename: Antonella
authors.initials: A
authors.lastname: Moreo
authors.forename: Nicola
authors.initials: N
authors.lastname: Gaibazzi
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiemann
authors.forename: Bharati
authors.initials: B
authors.lastname: Shivalkar
authors.forename: Stephan
authors.initials: S
authors.lastname: von Bardeleben
authors.forename: Leonarda
authors.initials: L
authors.lastname: Galiuto
authors.forename: Hervé
authors.initials: H
authors.lastname: Lardoux
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trocino
authors.forename: Ignasi
authors.initials: I
authors.lastname: Carrió
authors.forename: Dominique
authors.initials: D
authors.lastname: Le Guludec
authors.forename: Gianmario
authors.initials: G
authors.lastname: Sambuceti
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
authors.forename: Paolo
authors.initials: P
authors.lastname: Colonna
authors.forename: Folkert
authors.initials: F
authors.lastname: Ten Cate
authors.forename: Ezio
authors.initials: E
authors.lastname: Bramucci
authors.forename: Ariel
authors.initials: A
authors.lastname: Cohen
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Bezante
authors.forename: Costantina
authors.initials: C
authors.lastname: Aggeli
authors.forename: Jaroslaw D
authors.initials: JD
authors.lastname: Kasprzak
mesh_terms: D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005060:Europe; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D003287:Contrast Media; D017256:Technetium Tc 99m Sestamibi; D013459:Sulfur Hexafluoride
keywords: AUC; CA; CMR; LAD; LCx; MCE; MI; MVD; SE; SPECT; SVD; SonoVue; area under receiver-operating characteristic curve; cardiovascular resonance imaging; contrast echocardiography; coronary angiography; ischemia; left anterior descending artery; left circumflex artery; mechanical index; multivessel disease; myocardial contrast echocardiography; single vessel disease; single-photon emission computed tomography; stress echocardiography