title: Regadenoson Stress Real-Time Myocardial Perfusion Echocardiography for Detection of Coronary Artery Disease: Feasibility and Accuracy of Two Different Ultrasound Contrast Agents.
abstract: BACKGROUND
  The aim of this study was to compare the efficacy of myocardial perfusion (MP) and wall motion (WM) analysis obtained with real-time myocardial contrast echocardiography (RTMCE) and two widely used contrast agents in detecting coronary artery disease after injection of the vasodilator regadenoson.
  
  
  METHODS
  One hundred fifty patients were studied at two academic centers using regadenoson (400-μg intravenous bolus) vasodilator stress RTMCE (7.5% Optison infusion [n = 50] or 1.5% Definity infusion [n = 100]). Both MP and WM with RTMCE were analyzed at rest and after regadenoson bolus. Comparisons of WM and MP sensitivity, specificity, and accuracy were made. Quantitative angiography was performed in all patients within 1 month of the regadenoson stress study (>50% and >70% diameter stenosis was considered significant). Reviewers were blinded to all clinical and quantitative angiographic data.
  
  
  RESULTS
  Rate-pressure product after regadenoson was higher in Optison than Definity patients (P = .004). Using a 50% diameter stenosis on quantitative angiography as a reference standard, overall sensitivity, specificity, and accuracy for combined WM and MP analysis were not different for both agents (Optison, 77%, 64%, and 73%; Definity, 80%, 74%, and 78%; P = NS). The sensitivity, specificity, and accuracy of WM analysis alone for Optison were 68%, 71%, and 69% compared with 60%, 72%, and 66% for Definity (P = NS). Adding MP analysis improved the sensitivity and accuracy of Definity for detecting both >50% and >70% stenoses (P < .001 vs WM), while MP analysis did not improve the sensitivity of Optison for detecting either >50 or >70% stenoses.
  
  
  CONCLUSIONS
  RTMCE during regadenoson stress using either Optison or Definity is a rapid and effective method for the detection of coronary artery disease. The ability of MP imaging to improve WM accuracy may depend on the rate-pressure product achieved.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Abdelmoneim
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Mulvagh
authors.affiliation: Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.affiliation: Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Edward
authors.initials: E
authors.lastname: O'Leary
authors.affiliation: Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Mary
authors.initials: M
authors.lastname: Adolphson
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Omer
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lara F
authors.initials: LF
authors.lastname: Nhola
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Runqing
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Warta
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brenda
authors.initials: B
authors.lastname: Kirby
authors.affiliation: Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: trporter@unmc.edu.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D058908:Adenosine A2 Receptor Agonists / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011687:Purines / Q000008:administration & dosage*; D011720:Pyrazoles / Q000008:administration & dosage*; D015203:Reproducibility of Results
chemical_list: D058908:Adenosine A2 Receptor Agonists; D003287:Contrast Media; D011687:Purines; D011720:Pyrazoles; C430916:regadenoson
keywords: Coronary artery disease; Quantitative angiography; Real-time myocardial perfusion echocardiography; Regadenoson stress