Incremental value of parametric quantitative assessment of myocardial perfusion by triggered Low-Power myocardial contrast echocardiography

• Published in: Journal of the American College of Cardiology Vol. 43; no. 10; pp. 1807 - 1813
• Main Authors: Yu, Eric H.C, Skyba, Danny M, Leong-Poi, Howard, Sloggett, Cairrine, Jamorski, Michal, Garg, Rohit, Iwanochko, R.Mark, Siu, Samuel C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 19.05.2004; Elsevier Limited
• Subjects: Adult; Aged; Agreements; Albumins; Automation; Cardiology; Cardiovascular disease; Contrast agents; Contrast Media - pharmacology; Coronary Artery Disease - diagnostic imaging; Coronary Circulation; Coronary vessels; Echocardiography - methods; Exercise Test - methods; Female; Fluorocarbons; Heart attacks; Humans; Male; Medical imaging; Middle Aged; Patients; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tomography; Tomography, Emission-Computed, Single-Photon - methods; Massachusetts; VIS; CAD; TRI; MI; ROI; LAD; MCE; SPECT; MPQ
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2003.09.073

The purpose of this study was to compare the assessment of myocardial perfusion by myocardial parametric quantification (MPQ) with technetium-99m sestamibi single-photon emission computed tomographic (SPECT) imaging in humans. Accurate visual interpretation of myocardial contrast echocardiographic (MCE) images is qualitative and requires considerable experience. Current computer-assisted quantitative perfusion protocols are tedious and lack spatial resolution. Myocardial parametric quantification is a novel method that quantifies, color encodes, and displays perfusion data as a set of myocardial parametric images according to the relative degree of perfusion. Forty-six consecutive patients underwent prospective stress/rest technetium-99m sestamibi gated-SPECT imaging and MCE using intravenous Optison or Definity. Apical two- and four-chamber cine loops at rest and after dipyridamole (0.56 mg/kg) stress were acquired. For each patient, the following assessments of myocardial perfusion were performed: 1) visual cine-loop assessment (VIS); 2) MPQ assessment; and 3) combined VIS + MPQ assessment. The segmental rates of agreement for myocardial perfusion with SPECT were 83%, 89%, and 92% (kappa = 0.46, 0.58, and 0.68) for VIS, MPQ, and VIS + MPQ, respectively. Similar trends were seen for the classification of the presence or absence of a moderate to severe perfusion defect, with the agreement for VIS, MPQ, and VIS + MPQ being 92%, 97%, and 97%, respectively. Myocardial parametric quantification demonstrates good agreement with SPECT and incremental agreement with VIS. Analysis strategies that incorporate MPQ demonstrate better agreement with SPECT than visual analysis alone.