Rapid detection of coronary artery stenoses with real-time perfusion echocardiography during regadenoson stress

Thomas Richard Porter, Mary Adolphson, Robin R. High, Lynette M Smith, Joan Olson, Michelle Erdkamp, Feng Xie, Edward Lewis O'Leary, Benjamin F. Wong, Susan Eifert-Rain, Mary E. Hagen, Sahar S. Abdelmoneim, Sharon L. Mulvagh

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background-Real-time myocardial contrast echocardiography permits the detection of myocardial perfusion abnormalities during stress echocardiography, which may improve the accuracy of the test in detecting coronary artery stenoses. We hypothesized that this technique could be used after a bolus injection of the selective A2A receptor agonist regadenoson to rapidly and safely detect coronary artery stenoses. Methods and Results-In 100 patients referred for quantitative coronary angiography, real-time myocardial contrast echocardiography was performed during a continuous intravenous infusion of 3% Definity at baseline and at 2-minute intervals for up to 6 minutes after a regadenoson bolus injection (400 μg). Myocardial perfusion was assessed by examination of myocardial contrast replenishment after brief high mechanical index impulses. A perfusion defect was defined as a delay (>2 seconds) in myocardial contrast replenishment in 2 contiguous segments. Wall motion was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a >50% diameter stenosis was 80%/74%/78%, whereas for wall motion analysis it was 60%/72%/66% (P>0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first 2 minutes after regadenoson bolus (P<0.001 compared with wall motion), whereas wall motion sensitivity was highest at the 4-to-6 -minute period after the bolus. No significant side effects occurred after regadenoson bolus injection. Conclusions-Regadenoson real-time myocardial contrast echocardiography appears to be a feasible, safe, and rapid noninvasive method for the detection of significant coronary artery stenoses.

Original languageEnglish (US)
Pages (from-to)628-635
Number of pages8
JournalCirculation: Cardiovascular Imaging
Volume4
Issue number6
DOIs
StatePublished - Nov 1 2011

Fingerprint

Coronary Stenosis
Echocardiography
Perfusion
Injections
Stress Echocardiography
Coronary Angiography
Intravenous Infusions
Pathologic Constriction
regadenoson
Sensitivity and Specificity

Keywords

  • Contrast
  • Echocardiography
  • Myocardial perfusion imaging
  • Stress
  • Vasodilation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Rapid detection of coronary artery stenoses with real-time perfusion echocardiography during regadenoson stress. / Porter, Thomas Richard; Adolphson, Mary; High, Robin R.; Smith, Lynette M; Olson, Joan; Erdkamp, Michelle; Xie, Feng; O'Leary, Edward Lewis; Wong, Benjamin F.; Eifert-Rain, Susan; Hagen, Mary E.; Abdelmoneim, Sahar S.; Mulvagh, Sharon L.

In: Circulation: Cardiovascular Imaging, Vol. 4, No. 6, 01.11.2011, p. 628-635.

Research output: Contribution to journalArticle

Porter, Thomas Richard ; Adolphson, Mary ; High, Robin R. ; Smith, Lynette M ; Olson, Joan ; Erdkamp, Michelle ; Xie, Feng ; O'Leary, Edward Lewis ; Wong, Benjamin F. ; Eifert-Rain, Susan ; Hagen, Mary E. ; Abdelmoneim, Sahar S. ; Mulvagh, Sharon L. / Rapid detection of coronary artery stenoses with real-time perfusion echocardiography during regadenoson stress. In: Circulation: Cardiovascular Imaging. 2011 ; Vol. 4, No. 6. pp. 628-635.
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abstract = "Background-Real-time myocardial contrast echocardiography permits the detection of myocardial perfusion abnormalities during stress echocardiography, which may improve the accuracy of the test in detecting coronary artery stenoses. We hypothesized that this technique could be used after a bolus injection of the selective A2A receptor agonist regadenoson to rapidly and safely detect coronary artery stenoses. Methods and Results-In 100 patients referred for quantitative coronary angiography, real-time myocardial contrast echocardiography was performed during a continuous intravenous infusion of 3{\%} Definity at baseline and at 2-minute intervals for up to 6 minutes after a regadenoson bolus injection (400 μg). Myocardial perfusion was assessed by examination of myocardial contrast replenishment after brief high mechanical index impulses. A perfusion defect was defined as a delay (>2 seconds) in myocardial contrast replenishment in 2 contiguous segments. Wall motion was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a >50{\%} diameter stenosis was 80{\%}/74{\%}/78{\%}, whereas for wall motion analysis it was 60{\%}/72{\%}/66{\%} (P>0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first 2 minutes after regadenoson bolus (P<0.001 compared with wall motion), whereas wall motion sensitivity was highest at the 4-to-6 -minute period after the bolus. No significant side effects occurred after regadenoson bolus injection. Conclusions-Regadenoson real-time myocardial contrast echocardiography appears to be a feasible, safe, and rapid noninvasive method for the detection of significant coronary artery stenoses.",
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AU - Adolphson, Mary

AU - High, Robin R.

AU - Smith, Lynette M

AU - Olson, Joan

AU - Erdkamp, Michelle

AU - Xie, Feng

AU - O'Leary, Edward Lewis

AU - Wong, Benjamin F.

AU - Eifert-Rain, Susan

AU - Hagen, Mary E.

AU - Abdelmoneim, Sahar S.

AU - Mulvagh, Sharon L.

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AB - Background-Real-time myocardial contrast echocardiography permits the detection of myocardial perfusion abnormalities during stress echocardiography, which may improve the accuracy of the test in detecting coronary artery stenoses. We hypothesized that this technique could be used after a bolus injection of the selective A2A receptor agonist regadenoson to rapidly and safely detect coronary artery stenoses. Methods and Results-In 100 patients referred for quantitative coronary angiography, real-time myocardial contrast echocardiography was performed during a continuous intravenous infusion of 3% Definity at baseline and at 2-minute intervals for up to 6 minutes after a regadenoson bolus injection (400 μg). Myocardial perfusion was assessed by examination of myocardial contrast replenishment after brief high mechanical index impulses. A perfusion defect was defined as a delay (>2 seconds) in myocardial contrast replenishment in 2 contiguous segments. Wall motion was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a >50% diameter stenosis was 80%/74%/78%, whereas for wall motion analysis it was 60%/72%/66% (P>0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first 2 minutes after regadenoson bolus (P<0.001 compared with wall motion), whereas wall motion sensitivity was highest at the 4-to-6 -minute period after the bolus. No significant side effects occurred after regadenoson bolus injection. Conclusions-Regadenoson real-time myocardial contrast echocardiography appears to be a feasible, safe, and rapid noninvasive method for the detection of significant coronary artery stenoses.

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KW - Vasodilation

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