Prospective Randomized Comparison of Conventional Stress Echocardiography and Real-Time Perfusion Stress Echocardiography in Detecting Significant Coronary Artery Disease

• Published in: Journal of the American Society of Echocardiography Vol. 25; no. 11; pp. 1207 - 1214
• Main Authors: Thomas, Deepak, MD, Xie, Feng, MD, Smith, Lynette M., MS, O'Leary, Edward, MD, Smith, Kara, MS, Olson, Joan, RDCS, Nalty, Kevin, RN, Hess, Roberta, RN, Graham, Michelle, RN, Therrien, Stacey, BS, Porter, Thomas R., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.11.2012
• Subjects: Cardiovascular; Computer Systems; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Dobutamine; Echocardiography, Stress - methods; Female; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Myocardial Perfusion Imaging - methods; Perfusion imaging; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Stress echocardiography; Vasodilator Agents; LCX; FDA; LVO; RTMCE; ESE; Left ventricular opacification; WM; DSE; PPV; US Food and Drug Administration; MI; Stress echocardiography; MP; Exercise stress echocardiography; Mechanical index; CAD; Wall motion; Left anterior descending coronary artery; Coronary artery disease; LAD; Real-time myocardial contrast echocardiography; RCA; Right coronary artery; Dobutamine stress echocardiography; Perfusion imaging; Myocardial contrast replenishment; Positive predictive value; Myocardial perfusion; MCR; Left circumflex coronary artery
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2012.08.016

Background Although retrospective studies have suggested that myocardial perfusion and wall motion analysis with real-time myocardial contrast echocardiography (RTMCE) improves the detection of coronary artery disease (CAD) during dobutamine or exercise stress echocardiography, a prospective randomized comparison with conventional stress echocardiography that did not use RTMCE has not been performed. Methods A total of 1,776 patients with preserved resting left ventricular wall motion undergoing dobutamine or exercise stress echocardiography for suspicion of CAD were randomized to either non-RTMCE, for which contrast was used only for the approved indication of enhancing left ventricular opacification, or RTMCE, for which contrast infusion was used in all cases to examine both wall motion and myocardial perfusion. Comparisons in test positivity, and positive predictive value in those subsequently referred for quantitative coronary angiography, were performed. Results Patients randomized to RTMCE had significantly higher test positivity (22% for RTMCE vs 15% with non-RTMCE, P  = .0002). The increased test positivity occurred without a difference in positive predictive value in predicting >50% diameter stenoses by quantitative coronary angiography (67% for non-RTMCE, 73% for RTMCE). The mechanism for increased detection of CAD with RTMCE was mostly due to the detection of subendocardial wall thickening abnormalities that would have gone undetected when examining transmural wall thickening. Conclusions RTMCE improves the detection of CAD during dobutamine and exercise stress echocardiography, mainly by the detection of subendocardial ischemia.