Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease

Elhendy, Abdou; O’Leary, Edward; Xie, Feng; McGrain, Anna C.; Anderson, James R.; Porter, Thomas R.

doi:10.1016/j.jacc.2004.08.059

Cited by 163 publications

(104 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In recent years, myocardial contrast echocardiography has been demonstrated to be a feasible and accurate method for the evaluation of myocardial perfusion in many clinical settings (2)(3)(4)(5). In addition, the combination of intravenous contrast agents and RTMCE with application of high-mechanical index impulses for microbubble destruction followed by myocardial replenishment has permitted the quantification of myocardial blood flow (19,20).…”

Section: Discussionmentioning

confidence: 99%

“…The development of low-mechanical index imaging techniques that cause minimal microbubble destruction has permitted simultaneous analysis of myocardial perfusion and function in real time (2). Real-time myocardial contrast echocardiography (RTMCE) increases the sensitivity of dobutamine stress testing for the detection of coronary artery disease (3,4) and can distinguish between stunned and infarcted myocardium after acute ischemia (5). However, some concerns regarding the safety of this new imaging modality remain, mainly because some animal studies have demonstrated damage to the endothelial system in the presence of microbubbles and ultrasound (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Dourado

Tsutsui

Santos

et al. 2006

Braz J Med Biol Res

View full text Add to dashboard Cite

Myocardial contrast echocardiography has been used for assessing myocardial perfusion. Some concerns regarding its safety still remain, mainly regarding the induction of microvascular alterations. We sought to determine the bioeffects of microbubbles and real-time myocardial contrast echocardiography (RTMCE) in a closed-chest canine model. Eighteen mongrel dogs were randomly assigned to two groups. Nine were submitted to continuous intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) plus continuous imaging using power pulse inversion RTMCE for 180 min, associated with manually deflagrated high-mechanical index impulses. The control group consisted of 3 dogs submitted to continuous imaging using RTMCE without PESDA, 3 dogs received PESDA alone, and 3 dogs were sham-operated. Hemodynamics and cardiac rhythm were monitored continuously. Histological analysis was performed on cardiac and pulmonary tissues. No hemodynamic changes or cardiac arrhythmias were observed in any group. Normal left ventricular ejection fraction and myocardial perfusion were maintained throughout the protocol. Frequency of mild and focal microhemorrhage areas in myocardial and pulmonary tissue was similar in PESDA plus RTMCE and control groups. The percentages of positive microscopical fields in the myocardium were 0.4 and 0.7% (P = NS) in the PESDA plus RTMCE and control groups, respectively, and in the lungs they were 2.1 and 1.1%, respectively (P = NS). In this canine model, myocardial perfusion imaging obtained with PESDA and RTMCE was safe, with no alteration in cardiac rhythm or left ventricular function. Mild and focal myocardial and pulmonary microhemorrhages were observed in both groups, and may be attributed to surgical tissue manipulation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Dourado

Tsutsui

Santos

et al. 2006

Braz J Med Biol Res

View full text Add to dashboard Cite

show abstract

“…Multiple studies have also used MCE in conjunction with dobutamine or vasodilator (adenosine or dipyridamole) stress to detect CAD with a sensitivity and specificity comparable with that of nuclear techniques (43)(44)(45). Two studies have demonstrated the incremental prognostic value of MCE over routine clinical assessment in risk-stratifying patients who present to the emergency room with chest pain syndromes (46,47).…”

Section: Myocardial Perfusionmentioning

confidence: 99%

Contrast echocardiography in Canada: Canadian Cardiovascular Society/Canadian Society of Echocardiography position paper

Honos

Amyot

Choy

et al. 2007

Canadian Journal of Cardiology

View full text Add to dashboard Cite

“…The interobserver agreement on the presence of reversible perfusion defects on MCPI in our laboratory is 92%. The intraobserver agreement is 92% (27). The anterior septum, mid-posterior septum, anterior wall, and adjacent apical segments were assigned to the left anterior descending coronary artery (LAD).…”

Section: Echocardiographic Imagingmentioning

confidence: 99%

“…To date, studies of myocardial perfusion in diabetic patients were performed mainly with nuclear techniques (12,13). Myocardial contrast echocardiography is a newly introduced technique for the evaluation of myocardial perfusion in patients with suspected CAD (27)(28)(29)(30)(31)(32)(33)(34)(35). Real-time imaging using low mechanical index pulse sequence schemes enhances the detection of microbubbles and reduces microbubble destruction.…”

mentioning

confidence: 99%

Noninvasive Diagnosis of Coronary Artery Disease in Patients With Diabetes by Dobutamine Stress Real-Time Myocardial Contrast Perfusion Imaging

et al. 2005

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -The aim of this study was to assess the accuracy of real-time myocardial contrast perfusion imaging (MCPI) during dobutamine stress in the diagnosis and localization of coronary artery disease (CAD) in patients with diabetes. Myocardial contrast echocardiography is a new technique that allows evaluation of myocardial perfusion. Its utility in diabetic patients has not been defined. RESEARCH DESIGN AND METHODS-Dobutamine-atropine stress test was performed in conjunction with MCPI using Optison or Definity at rest and at peak stress in 128 patients with diabetes and suspected CAD who underwent coronary angiography within 1 month. CAD was defined as Ն50% stenosis in one or more coronary artery. MCPI was considered diagnostic of CAD in the presence of reversible perfusion abnormalities. The normalcy rate of MCPI was additionally determined in 18 asymptomatic nondiabetic patients with low probability.RESULTS -CAD was detected in 101 (79%) patients by angiography. Reversible perfusion abnormalities were detected in 90 patients with and 13 patients without CAD. The overall sensitivity of MCPI was 89% (95% CI 83-95), specificity 52% (33-71), and accuracy 81% (75-88). Reversible abnormalities were detected in two or more vascular distributions in 44 of 56 patients with multivessel CAD and in 8 of 63 patients without (sensitivity 68%, specificity 87%, positive predictive value 84%, and accuracy 79%). Regional sensitivity was 75% (65-85) for left anterior descending CAD, 71% (60 -83) for left circumflex, and 67% (55-78) for right CAD. MCPI was normal in 16 of the 18 patients with low clinical probability of CAD (normalcy rate 89%).CONCLUSIONS -MCPI is a useful noninvasive technique for the diagnosis and localization of CAD in diabetic patients. The extent of perfusion abnormalities can identify patients with multivessel CAD with a moderate sensitivity and high specificity. Diabetes Care 28:1662-1667, 2005C oronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with diabetes (1-5). Among patients with CAD, diabetes is associated with a worse prognosis (6 -8). Angiographic studies have shown that patients with diabetes have more advanced CAD at the time of the diagnosis. Although coronary angiography remains the gold standard, the expense and risk associated with this procedure prohibit its routine use for diagnosis of CAD.Various noninvasive stress imaging modalities are currently available for the evaluation of CAD in diabetic patients (10 -23). However, there are scarce data regarding the ability of noninvasive imaging techniques to identify multivessel CAD based on abnormalities in multivascular regions. This information is important since the extent of CAD determines the outcome, as well as potential benefit, of revascularization (24,25). Dobutamine stress echocardiography (DSE) has been reported as a safe method for evaluation of CAD in diabetic patients (23). Nevertheless, there are limited data regarding the diagnostic accuracy of this technique. Previous studies included in...

show abstract

Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease

Cited by 163 publications

References 33 publications

Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Bioeffects of albumin-encapsulated microbubbles and real-time myocardial contrast echocardiography in an experimental canine model

Contrast echocardiography in Canada: Canadian Cardiovascular Society/Canadian Society of Echocardiography position paper

Noninvasive Diagnosis of Coronary Artery Disease in Patients With Diabetes by Dobutamine Stress Real-Time Myocardial Contrast Perfusion Imaging

Contact Info

Product

Resources

About