Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography

Comparison with single photon emission computed tomography

Sarah Shimoni, William A. Zoghbi, Feng Xie, David Kricsfeld, Sherif Iskander, Lisa Gobar, Issam A. Mikati, John Abukhalil, Mario S. Verani, Edward Lewis O'Leary, Thomas Richard Porter

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: We sought to determine the feasibility and accuracy of real-time imaging of myocardial contrast echocardiography (MCE) in detecting myocardial perfusion defects during exercise echocardiography compared with radionuclide tomography. BACKGROUND: Ultrasound imaging at a low mechanical index and frame rate (10 to 20 Hz) after intravenous injections of perfluorocarbon containing microbubbles has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously and in real time. METHODS: One hundred consecutive patients with intermediate-to-high probability of coronary artery disease underwent treadmill (n = 50) or supine bicycle (n = 50) exercise echocardiography. Segmental perfusion with MCE and WM were assessed in real time before and at peak exercise using low mechanical index (0.3) and frame rates of 10 to 20 Hz after 0.3 ml bolus injections of intravenous Optison (Mallinckrodt Inc., San Diego, California). All patients had a dual isotope (rest thallium-201, stress sestamibi) study performed during the same exercise session, and 44 patients had subsequent quantitative coronary angiography. RESULTS: In the 100 patients, agreement between MCE and single photon emission computed tomography (SPECT) was 76%, while it was 88% between MCE and WM assessment. Compared with quantitative angiography, sensitivity of MCE, SPECT and WM was comparable (75%), with a specificity ranging from 81% to 100%. The combination of MCE and WM had the best balance between sensitivity and specificity (86% and 88%, respectively) with the highest accuracy (86%). CONCLUSIONS: The real-time assessment of myocardial perfusion during exercise stress echocardiography can be achieved with imaging at low mechanical index and frame rates. The combination of WM and MCE correlates well with SPECT and is a promising important addition to conventional stress echocardiography.

Original languageEnglish (US)
Pages (from-to)741-747
Number of pages7
JournalJournal of the American College of Cardiology
Volume37
Issue number3
DOIs
StatePublished - Mar 1 2001

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Single-Photon Emission-Computed Tomography
Echocardiography
Perfusion
Exercise
Stress Echocardiography
Intravenous Injections
Fluorocarbons
Microbubbles
Thallium
Coronary Angiography
Radioisotopes
Isotopes
Coronary Artery Disease
Ultrasonography
Angiography
Tomography
Sensitivity and Specificity

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography : Comparison with single photon emission computed tomography. / Shimoni, Sarah; Zoghbi, William A.; Xie, Feng; Kricsfeld, David; Iskander, Sherif; Gobar, Lisa; Mikati, Issam A.; Abukhalil, John; Verani, Mario S.; O'Leary, Edward Lewis; Porter, Thomas Richard.

In: Journal of the American College of Cardiology, Vol. 37, No. 3, 01.03.2001, p. 741-747.

Research output: Contribution to journalArticle

Shimoni, Sarah ; Zoghbi, William A. ; Xie, Feng ; Kricsfeld, David ; Iskander, Sherif ; Gobar, Lisa ; Mikati, Issam A. ; Abukhalil, John ; Verani, Mario S. ; O'Leary, Edward Lewis ; Porter, Thomas Richard. / Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography : Comparison with single photon emission computed tomography. In: Journal of the American College of Cardiology. 2001 ; Vol. 37, No. 3. pp. 741-747.
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abstract = "OBJECTIVES: We sought to determine the feasibility and accuracy of real-time imaging of myocardial contrast echocardiography (MCE) in detecting myocardial perfusion defects during exercise echocardiography compared with radionuclide tomography. BACKGROUND: Ultrasound imaging at a low mechanical index and frame rate (10 to 20 Hz) after intravenous injections of perfluorocarbon containing microbubbles has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously and in real time. METHODS: One hundred consecutive patients with intermediate-to-high probability of coronary artery disease underwent treadmill (n = 50) or supine bicycle (n = 50) exercise echocardiography. Segmental perfusion with MCE and WM were assessed in real time before and at peak exercise using low mechanical index (0.3) and frame rates of 10 to 20 Hz after 0.3 ml bolus injections of intravenous Optison (Mallinckrodt Inc., San Diego, California). All patients had a dual isotope (rest thallium-201, stress sestamibi) study performed during the same exercise session, and 44 patients had subsequent quantitative coronary angiography. RESULTS: In the 100 patients, agreement between MCE and single photon emission computed tomography (SPECT) was 76{\%}, while it was 88{\%} between MCE and WM assessment. Compared with quantitative angiography, sensitivity of MCE, SPECT and WM was comparable (75{\%}), with a specificity ranging from 81{\%} to 100{\%}. The combination of MCE and WM had the best balance between sensitivity and specificity (86{\%} and 88{\%}, respectively) with the highest accuracy (86{\%}). CONCLUSIONS: The real-time assessment of myocardial perfusion during exercise stress echocardiography can be achieved with imaging at low mechanical index and frame rates. The combination of WM and MCE correlates well with SPECT and is a promising important addition to conventional stress echocardiography.",
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T1 - Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography

T2 - Comparison with single photon emission computed tomography

AU - Shimoni, Sarah

AU - Zoghbi, William A.

AU - Xie, Feng

AU - Kricsfeld, David

AU - Iskander, Sherif

AU - Gobar, Lisa

AU - Mikati, Issam A.

AU - Abukhalil, John

AU - Verani, Mario S.

AU - O'Leary, Edward Lewis

AU - Porter, Thomas Richard

PY - 2001/3/1

Y1 - 2001/3/1

N2 - OBJECTIVES: We sought to determine the feasibility and accuracy of real-time imaging of myocardial contrast echocardiography (MCE) in detecting myocardial perfusion defects during exercise echocardiography compared with radionuclide tomography. BACKGROUND: Ultrasound imaging at a low mechanical index and frame rate (10 to 20 Hz) after intravenous injections of perfluorocarbon containing microbubbles has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously and in real time. METHODS: One hundred consecutive patients with intermediate-to-high probability of coronary artery disease underwent treadmill (n = 50) or supine bicycle (n = 50) exercise echocardiography. Segmental perfusion with MCE and WM were assessed in real time before and at peak exercise using low mechanical index (0.3) and frame rates of 10 to 20 Hz after 0.3 ml bolus injections of intravenous Optison (Mallinckrodt Inc., San Diego, California). All patients had a dual isotope (rest thallium-201, stress sestamibi) study performed during the same exercise session, and 44 patients had subsequent quantitative coronary angiography. RESULTS: In the 100 patients, agreement between MCE and single photon emission computed tomography (SPECT) was 76%, while it was 88% between MCE and WM assessment. Compared with quantitative angiography, sensitivity of MCE, SPECT and WM was comparable (75%), with a specificity ranging from 81% to 100%. The combination of MCE and WM had the best balance between sensitivity and specificity (86% and 88%, respectively) with the highest accuracy (86%). CONCLUSIONS: The real-time assessment of myocardial perfusion during exercise stress echocardiography can be achieved with imaging at low mechanical index and frame rates. The combination of WM and MCE correlates well with SPECT and is a promising important addition to conventional stress echocardiography.

AB - OBJECTIVES: We sought to determine the feasibility and accuracy of real-time imaging of myocardial contrast echocardiography (MCE) in detecting myocardial perfusion defects during exercise echocardiography compared with radionuclide tomography. BACKGROUND: Ultrasound imaging at a low mechanical index and frame rate (10 to 20 Hz) after intravenous injections of perfluorocarbon containing microbubbles has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously and in real time. METHODS: One hundred consecutive patients with intermediate-to-high probability of coronary artery disease underwent treadmill (n = 50) or supine bicycle (n = 50) exercise echocardiography. Segmental perfusion with MCE and WM were assessed in real time before and at peak exercise using low mechanical index (0.3) and frame rates of 10 to 20 Hz after 0.3 ml bolus injections of intravenous Optison (Mallinckrodt Inc., San Diego, California). All patients had a dual isotope (rest thallium-201, stress sestamibi) study performed during the same exercise session, and 44 patients had subsequent quantitative coronary angiography. RESULTS: In the 100 patients, agreement between MCE and single photon emission computed tomography (SPECT) was 76%, while it was 88% between MCE and WM assessment. Compared with quantitative angiography, sensitivity of MCE, SPECT and WM was comparable (75%), with a specificity ranging from 81% to 100%. The combination of MCE and WM had the best balance between sensitivity and specificity (86% and 88%, respectively) with the highest accuracy (86%). CONCLUSIONS: The real-time assessment of myocardial perfusion during exercise stress echocardiography can be achieved with imaging at low mechanical index and frame rates. The combination of WM and MCE correlates well with SPECT and is a promising important addition to conventional stress echocardiography.

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