Regadenoson Stress Real-Time Myocardial Perfusion Echocardiography for Detection of Coronary Artery Disease: Feasibility and Accuracy of Two Different Ultrasound Contrast Agents

Sahar S. Abdelmoneim, Sharon L. Mulvagh, Feng Xie, Edward Lewis O'Leary, Mary Adolphson, Mohamed A. Omer, Lara F. Nhola, Runqing Huang, Sara J. Warta, Brenda Kirby, Thomas Richard Porter

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1393-1400
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume28
Issue number12
DOIs
StatePublished - Dec 1 2015

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Contrast Media
Echocardiography
Coronary Artery Disease
Perfusion
Pathologic Constriction
Vasodilator Agents
Sensitivity and Specificity
Angiography
Pressure
Myocardial Perfusion Imaging
regadenoson
Definity
FS 069
Injections

Keywords

  • Coronary artery disease
  • Quantitative angiography
  • Real-time myocardial perfusion echocardiography
  • Regadenoson stress

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Regadenoson Stress Real-Time Myocardial Perfusion Echocardiography for Detection of Coronary Artery Disease : Feasibility and Accuracy of Two Different Ultrasound Contrast Agents. / Abdelmoneim, Sahar S.; Mulvagh, Sharon L.; Xie, Feng; O'Leary, Edward Lewis; Adolphson, Mary; Omer, Mohamed A.; Nhola, Lara F.; Huang, Runqing; Warta, Sara J.; Kirby, Brenda; Porter, Thomas Richard.

In: Journal of the American Society of Echocardiography, Vol. 28, No. 12, 01.12.2015, p. 1393-1400.

Research output: Contribution to journalArticle

Abdelmoneim, Sahar S. ; Mulvagh, Sharon L. ; Xie, Feng ; O'Leary, Edward Lewis ; Adolphson, Mary ; Omer, Mohamed A. ; Nhola, Lara F. ; Huang, Runqing ; Warta, Sara J. ; Kirby, Brenda ; Porter, Thomas Richard. / Regadenoson Stress Real-Time Myocardial Perfusion Echocardiography for Detection of Coronary Artery Disease : Feasibility and Accuracy of Two Different Ultrasound Contrast Agents. In: Journal of the American Society of Echocardiography. 2015 ; Vol. 28, No. 12. pp. 1393-1400.
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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.",
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author = "Abdelmoneim, {Sahar S.} and Mulvagh, {Sharon L.} and Feng Xie and O'Leary, {Edward Lewis} and Mary Adolphson and Omer, {Mohamed A.} and Nhola, {Lara F.} and Runqing Huang and Warta, {Sara J.} and Brenda Kirby and Porter, {Thomas Richard}",
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T1 - Regadenoson Stress Real-Time Myocardial Perfusion Echocardiography for Detection of Coronary Artery Disease

T2 - Feasibility and Accuracy of Two Different Ultrasound Contrast Agents

AU - Abdelmoneim, Sahar S.

AU - Mulvagh, Sharon L.

AU - Xie, Feng

AU - O'Leary, Edward Lewis

AU - Adolphson, Mary

AU - Omer, Mohamed A.

AU - Nhola, Lara F.

AU - Huang, Runqing

AU - Warta, Sara J.

AU - Kirby, Brenda

AU - Porter, Thomas Richard

PY - 2015/12/1

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N2 - 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.

AB - 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.

KW - Coronary artery disease

KW - Quantitative angiography

KW - Real-time myocardial perfusion echocardiography

KW - Regadenoson stress

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