Advertisement

Comparison of usefulness of dipyridamole stress myocardial contrast echocardiography to technetium-99m sestamibi single-photon emission computed tomography for detection of coronary artery disease (PB127 Multicenter Phase 2 Trial results)

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jayaweera A.R.
        • Wei K.
        • Coggins M.
        • Bin J.-P.
        • Goodman N.C.
        • Kaul S.
        Fate of capillaries distal to a stenosis. Their role in determining coronary blood flow reserve.
        Am J Physiol. 1999; 46: H2363-H2372
        • Ismail S.
        • Jayaweera A.R.
        • Goodman N.C.
        • Camarano G.P.
        • Skyba D.M.
        • Kaul S.
        Detection of coronary stenoses and quantification of the degree and spatial extent of blood flow mismatch during coronary hyperemia with myocardial contrast echocardiography.
        Circulation. 1995; 91: 821-830
        • Porter T.R.
        • Xie F.
        • Kricsfeld A.
        • Kilzer K.
        Noninvasive identification of acute ischemia and reperfusion with contrast ultrasound using intravenous perfluoropropane-exposed sonicated dextrose albumin.
        J Am Coll Cardiol. 1995; 26: 33-40
        • Firschke C.
        • Lindner J.R.
        • Wei K.
        • Goodman N.C.
        • Skyba D.M.
        • Kaul S.
        Myocardial perfusion imaging in the setting of coronary artery stenosis and acute myocardial infarction using venous injection of a second generation echocardiographic contrast agent.
        Circulation. 1997; 96: 959-967
        • Masugata H.
        • Cotter B.
        • Peters B.
        • Ohmori K.
        • Mizushige K.
        • DeMaria A.N.
        Assessment of coronary stenosis severity and transmural perfusion gradient by myocardial contrast echocardiography. Comparison of gray-scale and B-mode with power Doppler imaging.
        Circulation. 2000; 102: 1427-1433
        • Kaul S.
        • Senior R.
        • Dittrich H.
        • Raval U.
        • Khattar R.
        • Lahiri A.
        Detection of coronary artery disease with myocardial contrast echocardiography. Comparison with 99mTc-sestamibi single-photon emission computed tomography.
        Circulation. 1997; 96: 785-792
        • Heinle S.K.
        • Noblin J.
        • Goree-Best P.
        • Mello A.
        • Ravad G.
        • Mull S.
        • Mammen P.
        • Grayburn P.
        Assessment of myocardial perfusion by harmonic power Doppler imaging at rest and during adenosine stress. Comparison with 99mTc-sestamibi SPECT imaging.
        Circulation. 2000; 102: 55-60
        • Porter T.R.
        • Li S.
        • Kricsfeld D.
        • Armbruster R.W.
        Detection of myocardial perfusion in multiple echocardiographic windows with one intravenous injection of microbubbles using transient response second harmonic imaging.
        J Am Coll Cardiol. 1997; 29: 791-799
        • Oraby M.A.
        • Hays J.
        • Maklady F.A.
        • El-Hawary A.A.
        • Zabalgoitia M.
        Assessment of myocardial perfusion during pharmacologic contrast stress echocardiography.
        Am J Cardiol. 2002; 89: 640-644
        • Gould K.L.
        • Lipscomb K.
        Effects on coronary stenoses on coronary flow reserve and resistance.
        Am J Cardiol. 1974; 34: 48-55
        • Wei K.
        • Jayaweera A.R.
        • Firoozan S.
        • Linka A.
        • Skyba D.M.
        • Kaul S.
        Quantification of myocardial blood flow using ultrasound-induced destruction of microbubbles administered as a constant venous infusion.
        Circulation. 1998; 97: 473-483
        • Wei K.
        • Jayaweera A.R.
        • Firoozan S.
        • Linka A.
        • Skyba D.M.
        • Kaul S.
        The basis for stenosis detection using venous administration of microbubbles during myocardial contrast echocardiography. Bolus of continuous infusion?.
        J Am Coll Cardiol. 1998; 32: 252-260
        • Villanueva F.S.
        • Gertz E.W.
        • Csikari M.
        • Pulido G.
        • Fisher D.
        • Sklenar J.
        Detection of coronary artery stenosis with power Doppler imaging.
        Circulation. 2001; 103: 2624-2630
      1. Leong-Poi H, Rim S, Christiansen J, Kaul S, Lindner J. Influence of microbubble shell properties on ultrasound signal during real-time contrast imaging. J Am Soc Echocardiogr 2002;15:1269–1276

        • Wei K.
        • Ragosta M.
        • Thorpe J.
        • Coggins M.
        • Moos S.
        • Kaul S.
        Non-invasive quantification of coronary blood flow reserve in humans using myocardial contrast echocardiography.
        Circulation. 2001; 103: 2560-2565
        • Armstrong W.F.
        • Pellikka P.A.
        • Ryan T.
        • Crouse L.
        • Zoghbi W.A.
        Stress echocardiography.
        J Am Soc Echocardiogr. 1998; 11: 97-104
        • Elliott A.T.
        • McKillop J.H.
        • Pringle S.D.
        • Gillen G.J.
        • Wilson J.T.
        • Lorimer A.R.
        • Dargie H.J.
        Simultaneous measurement of left ventricular function and perfusion.
        Eur J Nucl Med. 1990; 1990:7: 310-314
        • Porter T.R.
        • Xie F.
        • Silver M.
        • Kricsfeld D.
        • O’Leary E.
        Real-time perfusion imaging with low mechanical index pulse inversion Doppler imaging.
        J Am Coll Cardiol. 2001; 37: 748-753
        • Shimoni S.
        • Zoghbi W.A.
        • Xie F.
        • Kricsfeld D.
        • Iskander S.
        • Gobar L.
        • Mikati I.A.
        • Abukhalil J.
        • Verani M.S.
        • O’Leary E.L.
        • Porter T.R.
        Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography.
        J Am Coll Cardiol. 2001; 37: 741-747
        • Leong-Poi H.
        • Le E.
        • Rim S.-J.
        • Sakuma T.
        • Kaul S.
        • Wei K.
        Quantification of myocardial perfusion and determination of coronary stenosis severity during hyperemia using real-time myocardial contrast echocardiography.
        J Am Soc Echocardiogr. 2001; 14: 1173-1182
        • Firoozan S.
        Wei K. Linka A. Skyba D. Goodman NC. Kaul S. A canine model of chronic ischemic cardiomyopathy.
        Am J Physiol. 1999; 276: H446-H455
        • Bin J.-P.
        • Pelberg R.A.
        • Wei K.
        • Coggins M.
        • Goodman N.C.
        • Kaul S.
        Relation between regional function and coronary flow reserve in multivessel coronary artery stenosis.
        Am J Physiol. 2000; 279: H3058-H3064
        • Iliceto S.
        • Galiuto L.
        • Marchese A.
        • Cavallari D.
        • Colonna P.
        • Biasco G.
        • Rizzoni P.
        Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography.
        Am J Cardiol. 1996; 77: 441-445
        • Nagueh S.F.
        • Vaduganathan P.
        • Ali N.
        • Blaustein A.
        • Verani M.S.
        • Winters W.L.
        • Zoghbi W.A.
        Identification of hibernating myocardium.
        J Am Coll Cardiol. 1997; 29: 985-993