Abstract
We hypothesized that assessment of hyperemic myocardial blood flow (MBF) velocity
using myocardial contrast echocardiography (MCE) can detect coronary artery disease
(CAD). We also postulated that only a single MCE study during stress is required for
the detection of CAD in patients with normal function at rest. Patients with known
or suspected CAD referred for dipyridamole stress technetium-99m sestamibi single-photon
emission computed tomographic (SPECT) studies were enrolled. MCE was performed concurrently
with SPECT using continuous infusions of PB127 during intermittent harmonic power
Doppler imaging at multiple pulsing intervals. MCE and SPECT were compared in 43 of
54 patients who had adequate studies using both techniques. In 15 of the 43 patients,
coronary angiography was performed within 30 days of the MCE/SPECT tests. Overall
concordance for classification of patients as normal versus abnormal was 84% (κ =
0.63) between the 2 tests. When false-negative SPECT scans were corrected for results
of angiography, concordance increased to 93% (κ = 0.82). For territorial analysis,
concordance between MCE and SPECT for location of perfusion defects was 65% (κ = 0.41)
and 74% (κ = 0.61) after SPECT was corrected by angiography. In patients with normal
function at rest, a single stress MCE perfusion study allowed identification of CAD
with the same concordance as rest/stress perfusion studies. In conclusion, visual
assessment of regional differences in MBF velocity using PB127 allows detection of
CAD with good concordance compared with technetium-99m sestamibi SPECT. In patients
with normal left ventricular function at rest, a single stress PB127 MCE perfusion
study is adequate for the detection of CAD.
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Article info
Publication history
Accepted:
February 14,
2003
Received in revised form:
February 14,
2003
Received:
November 22,
2002
Footnotes
This study was supported by a grant from POINT Biomedical Corp., San Carlos, California. Dr. Wei was also supported by a Mentored Clinical Scientist Development Award (K08-HL03909) from the National Institutes of Health, Bethesda, Maryland.
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
