title: The feasibility and clinical utility of myocardial contrast echocardiography in clinical practice: results from the incorporation of myocardial perfusion assessment into clinical testing with stress echocardiography study.
abstract: BACKGROUND
  This prospective study investigated whether the incorporation of myocardial contrast echocardiography (MCE) into a clinical stress echocardiography service reproduces the benefits of assessing myocardial perfusion proved previously in research studies.
  
  
  METHODS
  MCE was performed during physiologic and pharmacologic clinical stress echocardiographic studies, and the value of myocardial perfusion to the reporting echocardiologists was categorized as of benefit (subclassified as incremental benefit over wall motion [WM] or greater confidence with WM) or of no added benefit. The presence and extent of inducible ischemia by WM and myocardial perfusion were documented and correlated with angiographic results in patients who underwent cardiac catheterization.
  
  
  RESULTS
  In total, 220 patients underwent simultaneous MCE during stress echocardiography by eight different operators. Overall, MCE was of benefit in 193 patients (88%), providing incremental benefit over WM in 25% and greater confidence with WM evaluation in 62%. MCE provided no added benefit in 27 patients (12%). MCE detected significantly more cases of ischemia than WM in the left anterior descending coronary artery territory (65% vs 53%, P = .02) and detected a greater ischemic burden than WM on a per patient basis (median, 5 [interquartile range, 3-8] vs 4 [interquartile range, 2-7] segments; P < .001) and across all coronary territories. MCE correctly identified a greater proportion of patients with multivessel disease than WM (76% vs 56%, P = .02) and a greater ischemic burden in patients with multivessel disease (median, 7 [interquartile range, 4-9] vs 5 [interquartile range, 1-8] segments; P < .001).
  
  
  CONCLUSIONS
  This prospective study is the first to demonstrate that the excellent feasibility and diagnostic utility of MCE, which have been documented in the research arena, are reproducible in the clinical arena.
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom; Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Benoy N
authors.initials: BN
authors.lastname: Shah
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Navtej S
authors.initials: NS
authors.lastname: Chahal
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhattacharyya
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Roussin
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Rajdeep S
authors.initials: RS
authors.lastname: Khattar
authors.affiliation: Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom; Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom. Electronic address: roxysenior@cardiac-research.org.
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D000368:Aged; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods*; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Coronary artery disease; Ischemia; Myocardial contrast echocardiography; Stress echocardiography