Clinical impact of second harmonic imaging and left heart contrast in echocardiographic stress testing

Finkelhor, Robert S.; Pajouh, Mehdi; Kett, Attila; Stefanski, Richelle; Bosich, Georgene; Youssefi, Mojtaba E; Bahler, Robert C.

doi:10.1016/s0002-9149(99)00851-6

Cited by 16 publications

(7 citation statements)

References 21 publications

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“…Since advanced disease is more likely to result in adverse outcomes, it should not be surprising that inducible WT abnormality turned out to be an important predictor of events in our study27. It is also important to realize that WT abnormalities are much better assessed on contrast echocardiography28–30, which might also explain the results seen in our study.…”

Section: Discussionsupporting

confidence: 54%

Prognostic Value of Dipyridamole Stress Myocardial Contrast Echocardiography: Comparison With Single Photon Emission Computed Tomography

Dawson

Kaul

Peters

et al. 2009

Journal of the American Society of Echocardiography

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Aims-Dipyridamole stress myocardial contrast echocardiography (MCE) can be used to detect coronary artery disease (CAD). Because it measures myocardial blood flow velocity in addition to measuring myocardial blood volume, we hypothesized that it should have greater prognostic utility compared to single photon emission computed tomography (SPECT), which only measures myocardial blood volume. Since blood flow mismatch precedes wall thickening (WT) abnormality during demand ischemia, we also postulated that perfusion on MCE will be superior to WT abnormality on echocardiography for this purpose.Methods and results-The incidence of non-fatal myocardial infarction and cardiac death was determined in 261 patients with known or suspected CAD over a mean follow-up of 14 months who underwent simultaneous dipyridamole stress MCE and 99m Tc-sestamibi SPECT. Comparisons of survival curves were conducted with stratified (and unstratified) log-rank tests. An abnormal MCE was found to be the best predictor of an adverse outcome (OR=23, 95% CI=6-201, p<0.0001) and provided incremental prognostic value over clinical variables (age >60 years, the presence of ≥3 cardiac risk factors, known peripheral vascular disease, prior MI, and left ventricular (LV) systolic function), inducible WT abnormalities, and SPECT. Prognosis was the worst in patients who had both abnormal MCE and inducible WT abnormalities and the best in those who had neither. Patients with abnormal MCE but no inducible WT abnormalities had an intermediate outcome.Conclusion-In patients with known or suspected CAD undergoing dipyridamole stress, MCE provides powerful prognostic information that is superior to clinical variables, ECG, LV systolic function, WT analysis, and SPECT. MCE may therefore serve as a method of choice for myocardial perfusion assessment in known or suspected CAD. Larger studies are needed to confirm these findings.

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Section: Discussionsupporting

confidence: 54%

Prognostic Value of Dipyridamole Stress Myocardial Contrast Echocardiography: Comparison With Single Photon Emission Computed Tomography

Dawson

Kaul

Peters

et al. 2009

Journal of the American Society of Echocardiography

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“…The recent development of harmonic imaging 29 has overcome the problem and we used it in our study, which be another reason why low-dose DSE had a better diagnostic value for MV in our study than in the previous studies. 22,23 Finally, the number of study patients was not enough to ascertain any discrepancy between dual SPECT and DSE, so it is not conclusive that positive idntification of MV by dual SPECT without functional recovery indicates residual stenosis of the infarct-related artery.…”

Section: Study Limitationsmentioning

confidence: 94%

Comparative Study of Dobutamine Stress Echocardiography and Dual Single-Photon Emission Computed Tomography (Thallium-201 and I-123 BMIPP) for Assessing Myocardial Viability After Acute Myocardial Infarction.

Yasugi

Koyanagi

Ohzono

et al. 2002

Circ J

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ssessment of myocardial viability (MV) is importantto predict functional recovery and future cardiac events in patients with acute myocardial infarction (AMI). 1,2 Dobutamine stress echocardiography (DSE), in particular using low-dose dobutamine, is an excellent method for diagnosing MV and predicting the recovery of left ventricular dysfunction after MI, as well as in those patients who have undergone after revascularization for chronic ischemic heart disease. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] 123 I-labelled 15-iodophenyl-3-R, S-methyl pentadecanoic acid (BMIPP) reflects the fatty acid utilization of the myocardium and is used with single-photon emission computed tomography (SPECT) for energy metabolism studies. 19 When myocardial ischemia occurs, there is prolonged impaired uptake of BMIPP. [19][20][21] Previous studies have demonstrated that concordant defects of perfusion and BMIPP scans represent scarred or non-viable tissue, a lower BMIPP uptake relative to perfusion (perfusion -BMIPP mismatch) indicates metabolically damaged but viable myocardium, and equivalently normal perfusion and BMIPP uptake represents normal or completely salvaged myocardium. 19,20,22,23 Furthermore, a perfusion -BMIPP mismatch is a good predictor of functional recovery after myocardial infarction. 23 Thus MV can be estimated by both DSE and dual-isotope simultaneous acquisition of myocardial perfusion with BMIPP. These methods, however, have their own merits and limitations, and have rarely been directly compared in the same patient following AMI to assess for their ability to diagnose MV and predict long-term functional recovery. 23 Methods Study PatientsThe study prospectively enrolled 35 consecutive patients (26 men, 9 women; mean age, 63±10 years) admitted with AMI between January 2000 and March 2001 who underwent both DSE and dual SPECT in the National Kyushu Medical Center. Diagnosis of AMI was based on typical chest pain lasting longer than 30 min, ST segment elevation Discordance between the 123 I-labelled 15-iodophenyl-3-R, S-methyl pentadecanoic acid (BMIPP) and 201 Tl findings may indicate myocardial viability (MV). This study compared dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) using the dual tracers for assessment of MV and prediction of functional recovery after acute myocardial infarction (AMI). DSE and dual SPECT were studied in 35 patients after AMI, of whom 28 underwent percutaneous coronary intervention in the acute stage. Dual SPECT was performed to compare the defect score of BMIPP and 201 Tl. The left ventricular wall motion score (WMS) was estimated during DSE and 6 months later to assess functional recovery of the infarct area. The rate of agreement of MV between dual SPECT and DSE was 89% (p<0.01), and the sensitivity and specificity of DSE for dual SPECT in MV assessment was 86% and 93%, respectively. The positive and negative predictive values for functional recovery by dual SPECT were 76% and 67%, respectively, and by DSE were 9...

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“…The diagnostic accuracy of second harmonic imaging with contrast agent during stress echocardiography has been reported as modest (70-80%) in previous studies. 21,22 Although oronary angiography has well-known limitations when used to diagnose the severity of coronary artery disease, further comparative study between contrast-enhanced second harmonic imaging and CK is needed to determine its diagnostic accuracy for detecting coronary artery disease.…”

Section: Study Limitationsmentioning

confidence: 99%

Color Kinesis During Contrast-Enhanced Dobutamine Stress Echocardiography. Feasibility and Applicability.

Takeuchi

Yoshitani

Miyazaki

et al. 2003

Circ J

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Accurate interpretation of dobutamine stress echocardiography (DSE) needs expertise. Color kinesis (CK) allows objective assessment of wall motion (WM), and its feasibility and accuracy are enhanced under harmonic imaging with contrast agents. To explore its utility, CK was performed in 41 unselected patients during contrast-enhanced DSE. After bolus injection of Levovist, the CK image was acquired in the apical 4- and 2-chamber views at baseline and peak stress using the ultraharmonic mode. Quad screen format with second harmonic imaging after another injection of Levovist was also obtained as a reference. Regional WM (12 segments in the apical view) was independently assessed by both methods. Heart rate increased from 67 beats/min at baseline to 135 beats/min (88% of age predicted maximal heart rate) at peak stress. The CK image was successfully obtained in all patients at baseline and in 38/41 patients at peak stress. CK tracked endocardial motion accurately in 93% (456/492) of left ventricular segments at baseline and 87% (427/492) at peak stress. The concordance rate of normal and abnormal WM between the 2 methods was 86% (392/456, Kappa 0.61) at baseline and 85% (362/427, kappa 0.53) at peak stress. Among the 38 patients in whom both methods were completed, the standard quad screen display showed abnormal DSE results in 17 patients and 28/114 vascular territories. The sensitivity, specificity and diagnostic accuracy of CK for detecting abnormal findings were, respectively, 71% (12/17), 90% (19/21) and 82% (31/38) in patients and 57% (16/28), 97% (83/86) and 87% (99/114) in vascular territories. The application of CK was highly feasible during contrast-enhanced DSE and gave an objective assessment of WM. This method can be a valuable adjunct to the conventional interpretation of DSE.

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Clinical impact of second harmonic imaging and left heart contrast in echocardiographic stress testing

Cited by 16 publications

References 21 publications

Prognostic Value of Dipyridamole Stress Myocardial Contrast Echocardiography: Comparison With Single Photon Emission Computed Tomography

Prognostic Value of Dipyridamole Stress Myocardial Contrast Echocardiography: Comparison With Single Photon Emission Computed Tomography

Comparative Study of Dobutamine Stress Echocardiography and Dual Single-Photon Emission Computed Tomography (Thallium-201 and I-123 BMIPP) for Assessing Myocardial Viability After Acute Myocardial Infarction.

Color Kinesis During Contrast-Enhanced Dobutamine Stress Echocardiography. Feasibility and Applicability.

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