Comparison of Dobutamine Stress Echocardiography With and Without Real-Time Perfusion Imaging for Detection of Coronary Artery Disease

Xie, Feng; Tsutsui, Jeane Mike; McGrain, Anna C.; DeMaria, Anthony N.; Cotter, Bruno; Becher, Harald; Lebleu, Curtis; Labovitz, Arthur J.; Picard, Michael H.; O’Leary, Edward; Porter, Thomas R.

doi:10.1016/j.amjcard.2005.04.010

Cited by 30 publications

(12 citation statements)

References 18 publications

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“…18,19 We have recently compared the ability of WM analyzed with high-mechanical-index harmonic imaging at frame rates Ͼ60 Hz without contrast against low-mechanical-index RTCE with intravenous ultrasound contrast during DSE to detect Ͼ50% diameter stenoses. 38 In this study, the sensitivity of the 2 WM analysis methods were not significantly different (33% without contrast, 40% with contrast). The sensitivities of both WM techniques in this pilot study were 30% lower than MP imaging.…”

Section: Role Of Mp and Wm Imaging With Rtce In Predicting Eventsmentioning

confidence: 46%

Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

et al. 2005

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Background-Myocardial perfusion (MP) imaging with real-time contrast echocardiography (RTCE) improves the sensitivity of dobutamine stress echocardiography for detecting coronary artery disease. Its prognostic value is unknown. We sought to determine the value of MP and wall motion (WM) analysis during dobutamine stress echocardiography in predicting the outcome of patients with known or suspected coronary artery disease. Methods and Results-We retrospectively studied 788 patients with RTCE during dobutamine stress echocardiography using intravenous commercially available contrast agents. The incremental prognostic value of MP imaging over clinical risk factors and other echocardiographic data was examined through the use of a log-likelihood test (Cox model). During a median follow-up of 20 months, 75 events (9.6%) occurred (58 deaths, 17 nonfatal myocardial infarctions). Abnormal MP had significant incremental value over clinical factors, resting ejection fraction, and WM responses in predicting events (PϽ0.001). By multivariate analysis, the independent predictors of death and nonfatal myocardial infarction were resting left ventricular ejection fraction Ͻ50% (relative risk [RR], 1.9; 95% CI, 1.2 to 3.2; Pϭ0.01), hypercholesterolemia (RR, 0.5; 95% CI, 0.3 to 0.9; Pϭ0.01), and abnormal MP (RR, 5.2; 95% CI, 3.0 to 9.0; PϽ0.0001). The 3-year event free survival was 95% for patients with normal WM and MP, 82% for normal WM and abnormal MP, and 68% for abnormal WM and MP. Conclusion-MP imaging during dobutamine stress RTCE provides incremental prognostic information in patients with known or suspected coronary artery disease. Patients with normal MP have a better outcome than patients with normal WM.

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Section: Role Of Mp and Wm Imaging With Rtce In Predicting Eventsmentioning

confidence: 46%

Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

et al. 2005

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“…The advantage of DSMR-perfusion regarding sensitivity, however, came at an increase in more false positive cases, especially in patients with C70% stenosis. A reduction in specificity was reported in previous studies comparing perfusion and wall motion during demand stress testing [7,16,20,21]. Compared to prior studies we applied a slightly more conservative approach for the definition of perfusion deficits (two segments vs. one segment for test positivity), which may have led to an improvement in specificity in patients with C50% stenosis [7].…”

Section: Discussionmentioning

confidence: 96%

Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

Gebker

Frick

Jahnke

et al. 2010

Int J Cardiovasc Imaging

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This study was performed to assess the role of additional myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR-wall motion) for the evaluation of patients with intermediate (50-70%) coronary artery stenosis. Routine DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 174 consecutive patients with chest pain syndromes who were scheduled for a clinically indicated coronary angiography. When defining CAD as the presence of a ≥ 50% stenosis, the addition of perfusion imaging improved sensitivity (90 vs. 79%, P < 0.001) with a non-significant reduction in specificity (85 vs. 90%, P = 0.13) and an improvement in overall diagnostic accuracy (88 vs. 84%, P = 0.008). Adding perfusion imaging improved sensitivity in patients with intermediate stenosis (87 vs. 72%, P = 0.03), but not in patients with severe (≥70%) stenosis (93 vs. 84%, P = 0.06). In patients with severe stenosis specificity of DSMR-perfusion versus DSMR-wall motion decreased (61 vs 70%, P = 0.001) resulting in a lower overall accuracy (71 vs 74%, P = 0.03). Using a cutoff of ≥50% for the definition of CAD, sensitivity of DSMR-perfusion compared to DSMR-wall motion was significantly higher in patients with single vessel (88 vs. 77%, P = 0.03) and multi vessel disease (93 vs. 79%, P = 0.03), whereas no significant differences were found using a cutoff of ≥70% stenosis for the definition of CAD. The addition of perfusion imaging during DSMR-wall motion improved the sensitivity in patients with intermediate coronary artery stenosis. Overall diagnostic accuracy increased only when defining CAD as ≥50% stenosis. In patients with ≥70% stenosis DSMR-wall motion alone had higher accuracy due to more false-positive cases with DSMR-perfusion.

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“…Most reported a sensitivity of MCE for CAD detection that is similar to or higher than SPECT/DSE, ranging from 64% to 97%, compared with 33% to 100% for the latter (18,19,21,22,24,(27)(28)(29)(30)(31). Furthermore, the addition of MCE may improve sensitivity for detection of CAD over wall motion analysis during DSE (18,29,31,32). We performed a meta-analysis of these studies and determined that the sensitivity and specificity of MCE for detection of CAD are at least not inferior to SPECT/DSE (Table 2, Fig.…”

Section: Mce In Detecting Stable Coronary Artery Diseasementioning

confidence: 99%

Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion

Dijkmans

Senior

Becher

et al. 2006

Journal of the American College of Cardiology

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117

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Intravenous myocardial contrast echocardiography (MCE) is a recently developed technique for assessment of myocardial perfusion. Up to now, many studies have demonstrated that the sensitivity and specificity of qualitative assessment of myocardial perfusion by MCE in patients with acute and chronic ischemic heart disease are comparable with other techniques such as cardiac scintigraphy and dobutamine stress echocardiography. Furthermore, quantitative parameters of myocardial perfusion derived from MCE correlate well with the current clinical standard for this purpose, positron emission tomography. Myocardial contrast echocardiography provides a promising and valuable tool for assessment of myocardial perfusion. Although MCE has been primarily performed for medical research, its implementation in routine clinical care is evolving. This article is intended to give an overview of the current status of MCE.

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Comparison of Dobutamine Stress Echocardiography With and Without Real-Time Perfusion Imaging for Detection of Coronary Artery Disease

Cited by 30 publications

References 18 publications

Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion

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