Incremental benefit of myocardial contrast to combined dipyridamole-exercise stress echocardiography for the assessment of coronary artery disease

• Published in: Circulation (New York, N.Y.) Vol. 110; no. 9; pp. 1108 - 1113
• Main Authors: MOIR, Stuart, HALUSKA, Brian A, JENKINS, Carly, FATHI, Robert, MARWICK, Thomas H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 31.08.2004
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Comorbidity; Contrast Media; Coronary Angiography; Coronary Circulation - drug effects; Coronary Disease - diagnosis; Coronary Disease - diagnostic imaging; Coronary heart disease; Dipyridamole; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Echocardiography, Stress - methods; Exercise Test - methods; Female; Fluorocarbons; Heart; Humans; Hyperemia - physiopathology; Liposomes; Male; Medical sciences; Middle Aged; Risk Factors; Sensitivity and Specificity; Single-Blind Method; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Antianginal agent; Physical exercise; Echocardiography; Coronary vasodilator agent; Dipyridamole; Cardiovascular disease; exercise; myocardium; Coronary heart disease; Antiplatelet agent; Stress; coronary disease; Contrast media
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000139905.47128.9f

Although assessment of myocardial perfusion by myocardial contrast echocardiography (MCE) is feasible, its incremental benefit to stress echocardiography is not well defined. We examined whether the addition of MCE to combined dipyridamole-exercise echocardiography (DExE) provides incremental benefit for evaluation of coronary artery disease (CAD). MCE was combined with DExE in 85 patients, 70 of whom were undergoing quantitative coronary angiography and 15 patients with a low probability of CAD. MCE was acquired by low-mechanical-index imaging in 3 apical views after acquisition of standard resting and poststress images. Wall motion, left ventricular opacification, and MCE components of the study were interpreted sequentially, blinded to other data. Significant (>50%) stenoses were present in 43 patients and involved 69 coronary territories. The addition of qualitative MCE improved sensitivity for the detection of CAD (91% versus 74%, P=0.02) and accurate recognition of disease extent (87% versus 65% of territories, P=0.003), with a nonsignificant reduction in specificity. The addition of low-mechanical-index MCE to standard imaging during DExE improves detection of CAD and enables a more accurate determination of disease extent.