Safety of dobutamine stress real-time myocardial contrast echocardiography

Jeane M. Tsutsui, Abdou Elhendy, Feng Xie, Edward Lewis O'Leary, Anna C. McGrain, Thomas Richard Porter

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Objectives: The aim of this study was to determine the safety of dobutamine stress myocardial perfusion imaging (MPI) obtained by real-time contrast echocardiography (RTCE) and intravenous ultrasound contrast in a large cohort of patients with suspected coronary artery disease (CAD). Background: Despite the increasing number of studies showing the potential clinical utility of myocardial contrast perfusion imaging with commercially available contrast agents, the safety of this technique in a clinical setting has not been demonstrated. Methods: Over a four-year period, 1,486 patients underwent dobutamine stress RTCE with low mechanical index pulse sequence schemes after intravenous injections of commercially available contrast agents (35% Definity, Bristol Myers Squibb Medical Imaging Inc., North Billerica, Massachusetts; 65% Optison, GE-Amersham, Princeton, New Jersey). The hemodynamic and adverse effects of RTCE were compared with 1,012 patients who underwent conventional dobutamine stress echocardiography (DSE) without contrast. The feasibility of image analysis was defined as the ability to analyze MPI in at least two of the three standard segments in each left ventricular wall. Results: No myocardial infarction or death occurred during dobutamine stress. There was no difference in the incidence of nonsustained ventricular tachycardia, sustained ventricular tachycardia, or supraventricular tachycardia during dobutamine infusion between RTCE and DSE. Myocardial perfusion imaging was considered feasible for analysis in 94% of the walls at baseline and 95% at peak stress. The anterior, lateral, and posterior walls were the most common regions in which MPI was not feasible. Myocardial perfusion imaging with RTCE had a higher accuracy for detecting patients with angiographically significant CAD than the analysis of wall motion (84% vs. 66%, respectively; p < 0.001). Conclusions: Dobutamine stress RTCE appears to be a safe and feasible technique for evaluating patients with known or suspected CAD.

Original languageEnglish (US)
Pages (from-to)1235-1242
Number of pages8
JournalJournal of the American College of Cardiology
Volume45
Issue number8
DOIs
StatePublished - Apr 19 2005

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Myocardial Perfusion Imaging
Dobutamine
Echocardiography
Safety
Coronary Artery Disease
Stress Echocardiography
Ventricular Tachycardia
Contrast Media
Supraventricular Tachycardia
Diagnostic Imaging
Intravenous Injections
Hemodynamics
Myocardial Infarction
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Safety of dobutamine stress real-time myocardial contrast echocardiography. / Tsutsui, Jeane M.; Elhendy, Abdou; Xie, Feng; O'Leary, Edward Lewis; McGrain, Anna C.; Porter, Thomas Richard.

In: Journal of the American College of Cardiology, Vol. 45, No. 8, 19.04.2005, p. 1235-1242.

Research output: Contribution to journalArticle

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abstract = "Objectives: The aim of this study was to determine the safety of dobutamine stress myocardial perfusion imaging (MPI) obtained by real-time contrast echocardiography (RTCE) and intravenous ultrasound contrast in a large cohort of patients with suspected coronary artery disease (CAD). Background: Despite the increasing number of studies showing the potential clinical utility of myocardial contrast perfusion imaging with commercially available contrast agents, the safety of this technique in a clinical setting has not been demonstrated. Methods: Over a four-year period, 1,486 patients underwent dobutamine stress RTCE with low mechanical index pulse sequence schemes after intravenous injections of commercially available contrast agents (35{\%} Definity, Bristol Myers Squibb Medical Imaging Inc., North Billerica, Massachusetts; 65{\%} Optison, GE-Amersham, Princeton, New Jersey). The hemodynamic and adverse effects of RTCE were compared with 1,012 patients who underwent conventional dobutamine stress echocardiography (DSE) without contrast. The feasibility of image analysis was defined as the ability to analyze MPI in at least two of the three standard segments in each left ventricular wall. Results: No myocardial infarction or death occurred during dobutamine stress. There was no difference in the incidence of nonsustained ventricular tachycardia, sustained ventricular tachycardia, or supraventricular tachycardia during dobutamine infusion between RTCE and DSE. Myocardial perfusion imaging was considered feasible for analysis in 94{\%} of the walls at baseline and 95{\%} at peak stress. The anterior, lateral, and posterior walls were the most common regions in which MPI was not feasible. Myocardial perfusion imaging with RTCE had a higher accuracy for detecting patients with angiographically significant CAD than the analysis of wall motion (84{\%} vs. 66{\%}, respectively; p < 0.001). Conclusions: Dobutamine stress RTCE appears to be a safe and feasible technique for evaluating patients with known or suspected CAD.",
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