Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease

Abdou Elhendy, Edward Lewis O'Leary, Feng Xie, Anna C. McGrain, James R. Anderson, Thomas Richard Porter

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Abstract

This study sought to compare the accuracy of myocardial contrast echocardiography (MCE) and wall motion analysis (WMA) during submaximal and peak dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD). The relative merits of MCE and WMA for the detection of CAD during DSE have not been studied in a large number of patients. We studied 170 patients who underwent dobutamine (up to 50 μg/kg/min)-atropine stress testing and coronary angiography. The WMA and MCE (using repeated boluses of Optison [Mallinckrodt, St. Louis, Missouri] or Definity [Bristol-Myers Squibb, New York, New York]) were performed at rest, at intermediate stress (65% to 75% of maximal heart rate), and at peak stress. The diagnosis of CAD (≥50% stenosis in ≥1 coronary artery) was based on reversible wall motion and perfusion abnormalities. Coronary artery disease was detected in 127 (75%) patients. Sensitivity of MCE was higher than that of WMA at maximal stress (91% vs. 70%; p = 0.001) and at intermediate stress (84% vs. 20%; p = 0.0001). Specificity was lower for MCE compared with WMA (51% vs. 74%; p = 0.01). Overall accuracy was higher for MCE than for WMA (81% vs. 71%; p = 0.01). Sensitivity for detection of CAD based on abnormalities in ≥2 vascular regions was higher for MCE than for WMA (67% vs. 28%; p < 0.01). The majority of inducible perfusion abnormalities occur at an intermediate phase of the stress test, without wall motion abnormalities. Myocardial contrast echocardiography provides better sensitivity than WMA, particularly in patients with submaximal stress and in identifying patients with multivessel CAD.

Original languageEnglish (US)
Pages (from-to)2185-2191
Number of pages7
JournalJournal of the American College of Cardiology
Volume44
Issue number11
DOIs
StatePublished - Dec 7 2004

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Stress Echocardiography
Myocardial Perfusion Imaging
Coronary Artery Disease
Echocardiography
Perfusion
Dobutamine
Coronary Angiography
Atropine
Exercise Test
Blood Vessels
Coronary Vessels
Pathologic Constriction
Heart Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{f04aa76ee3514f279d7a6a022553426d,
title = "Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease",
abstract = "This study sought to compare the accuracy of myocardial contrast echocardiography (MCE) and wall motion analysis (WMA) during submaximal and peak dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD). The relative merits of MCE and WMA for the detection of CAD during DSE have not been studied in a large number of patients. We studied 170 patients who underwent dobutamine (up to 50 μg/kg/min)-atropine stress testing and coronary angiography. The WMA and MCE (using repeated boluses of Optison [Mallinckrodt, St. Louis, Missouri] or Definity [Bristol-Myers Squibb, New York, New York]) were performed at rest, at intermediate stress (65{\%} to 75{\%} of maximal heart rate), and at peak stress. The diagnosis of CAD (≥50{\%} stenosis in ≥1 coronary artery) was based on reversible wall motion and perfusion abnormalities. Coronary artery disease was detected in 127 (75{\%}) patients. Sensitivity of MCE was higher than that of WMA at maximal stress (91{\%} vs. 70{\%}; p = 0.001) and at intermediate stress (84{\%} vs. 20{\%}; p = 0.0001). Specificity was lower for MCE compared with WMA (51{\%} vs. 74{\%}; p = 0.01). Overall accuracy was higher for MCE than for WMA (81{\%} vs. 71{\%}; p = 0.01). Sensitivity for detection of CAD based on abnormalities in ≥2 vascular regions was higher for MCE than for WMA (67{\%} vs. 28{\%}; p < 0.01). The majority of inducible perfusion abnormalities occur at an intermediate phase of the stress test, without wall motion abnormalities. Myocardial contrast echocardiography provides better sensitivity than WMA, particularly in patients with submaximal stress and in identifying patients with multivessel CAD.",
author = "Abdou Elhendy and O'Leary, {Edward Lewis} and Feng Xie and McGrain, {Anna C.} and Anderson, {James R.} and Porter, {Thomas Richard}",
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T1 - Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease

AU - Elhendy, Abdou

AU - O'Leary, Edward Lewis

AU - Xie, Feng

AU - McGrain, Anna C.

AU - Anderson, James R.

AU - Porter, Thomas Richard

PY - 2004/12/7

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N2 - This study sought to compare the accuracy of myocardial contrast echocardiography (MCE) and wall motion analysis (WMA) during submaximal and peak dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD). The relative merits of MCE and WMA for the detection of CAD during DSE have not been studied in a large number of patients. We studied 170 patients who underwent dobutamine (up to 50 μg/kg/min)-atropine stress testing and coronary angiography. The WMA and MCE (using repeated boluses of Optison [Mallinckrodt, St. Louis, Missouri] or Definity [Bristol-Myers Squibb, New York, New York]) were performed at rest, at intermediate stress (65% to 75% of maximal heart rate), and at peak stress. The diagnosis of CAD (≥50% stenosis in ≥1 coronary artery) was based on reversible wall motion and perfusion abnormalities. Coronary artery disease was detected in 127 (75%) patients. Sensitivity of MCE was higher than that of WMA at maximal stress (91% vs. 70%; p = 0.001) and at intermediate stress (84% vs. 20%; p = 0.0001). Specificity was lower for MCE compared with WMA (51% vs. 74%; p = 0.01). Overall accuracy was higher for MCE than for WMA (81% vs. 71%; p = 0.01). Sensitivity for detection of CAD based on abnormalities in ≥2 vascular regions was higher for MCE than for WMA (67% vs. 28%; p < 0.01). The majority of inducible perfusion abnormalities occur at an intermediate phase of the stress test, without wall motion abnormalities. Myocardial contrast echocardiography provides better sensitivity than WMA, particularly in patients with submaximal stress and in identifying patients with multivessel CAD.

AB - This study sought to compare the accuracy of myocardial contrast echocardiography (MCE) and wall motion analysis (WMA) during submaximal and peak dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD). The relative merits of MCE and WMA for the detection of CAD during DSE have not been studied in a large number of patients. We studied 170 patients who underwent dobutamine (up to 50 μg/kg/min)-atropine stress testing and coronary angiography. The WMA and MCE (using repeated boluses of Optison [Mallinckrodt, St. Louis, Missouri] or Definity [Bristol-Myers Squibb, New York, New York]) were performed at rest, at intermediate stress (65% to 75% of maximal heart rate), and at peak stress. The diagnosis of CAD (≥50% stenosis in ≥1 coronary artery) was based on reversible wall motion and perfusion abnormalities. Coronary artery disease was detected in 127 (75%) patients. Sensitivity of MCE was higher than that of WMA at maximal stress (91% vs. 70%; p = 0.001) and at intermediate stress (84% vs. 20%; p = 0.0001). Specificity was lower for MCE compared with WMA (51% vs. 74%; p = 0.01). Overall accuracy was higher for MCE than for WMA (81% vs. 71%; p = 0.01). Sensitivity for detection of CAD based on abnormalities in ≥2 vascular regions was higher for MCE than for WMA (67% vs. 28%; p < 0.01). The majority of inducible perfusion abnormalities occur at an intermediate phase of the stress test, without wall motion abnormalities. Myocardial contrast echocardiography provides better sensitivity than WMA, particularly in patients with submaximal stress and in identifying patients with multivessel CAD.

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