Rapid Detection of Coronary Artery Stenoses With Real-Time Perfusion Echocardiography During Regadenoson Stress

Abstract

Background-Real-time myocardial contrast echocardiography permits the detection of myocardial perfusion abnormalities during stress echocardiography, which may improve the accuracy of the test in detecting coronary artery stenoses. We hypothesized that this technique could be used after a bolus injection of the selective A2A receptor agonist regadenoson to rapidly and safely detect coronary artery stenoses. Methods and Results-In 100 patients referred for quantitative coronary angiography, real-time myocardial contrast echocardiography was performed during a continuous intravenous infusion of 3% Definity at baseline and at 2-minute intervals for up to 6 minutes after a regadenoson bolus injection (400 g). Myocardial perfusion was assessed by examination of myocardial contrast replenishment after brief high mechanical index impulses. A perfusion defect was defined as a delay (Ͼ2 seconds) in myocardial contrast replenishment in 2 contiguous segments. Wall motion was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a Ͼ50% diameter stenosis was 80%/74%/78%, whereas for wall motion analysis it was 60%/72%/66% (PϽ0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first 2 minutes after regadenoson bolus (PϽ0.001 compared with wall motion), whereas wall motion sensitivity was highest at the 4-to-6 -minute period after the bolus. No significant side effects occurred after regadenoson bolus injection. Conclusions-Regadenoson

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

“…1258,1259 Recent reports of contrast echocardiography MPI during vasodilating stress indicate that it is a potentially robust and clinically viable tool in detection of CAD. 1260 Finally, 3-dimensional techniques can provide an improved assessment of cardiac size and function in patients with SIHD.…”

Qualitative and Quantitative Assessment of Adenosine Triphosphate Stress Whole-Heart Dynamic Myocardial Perfusion Imaging Using 256-Slice Computed Tomography

“…Myocardial perfusion abnormality, which is the first step in the ischemic cascade, has been evaluated with nuclear medicine [5-8], magnetic resonance (MR) imaging [9,10], and echocardiography [11] for risk stratification of myocardial ischemia. Recently, several studies have shown that pharmacological stress myocardial CT perfusion (CTP) imaging can be used to evaluate myocardial ischemia by two methods [12-20].…”

The Incremental Prognostic Value of the Incorporation of Myocardial Perfusion Assessment into Clinical Testing with Stress Echocardiography Study

“…However, MCE readings of two other operators suggest that they have good agreement with the expert (unlike the expert reader, the two other cardiologists who assessed studies for interobserver variability did so without knowledge of the patients' demographics, symptoms, or electrocardiographic findings), and the values are consistent with other recent myocardial contrast echocardiographic studies. 19,20 Indeed, today, stress and myocardial contrast echocardiographic studies are interpreted by four readers independently in the SE laboratory. Third, this was a high-risk patient cohort (almost half had histories of AMI and of revascularization) typical of a population referred to a tertiary referral center, and thus caution is required before extrapolating these results to lower risk patients.…”