The Value of Quantitative Real‐Time Myocardial Contrast Echocardiography for Detection of Angiographically Significant Coronary Artery Disease

Abstract

Background: Real-time (RT) myocardial contrast echocardiography (MCE) is a novel method for the assessment of regional myocardial perfusion. We sought to evaluate the feasibility and diagnostic accuracy of quantitative RT-MCE in predicting significant coronary stenosis, with reference to quantitative coronary angiography. Hypothesis: RT-MCE can identify anatomically significant coronary artery stenosis in selected patients. RT-MCE is probably an effective method for detection of angiographically significant coronary artery stenosis. Methods: Thirty-five patients (mean age, 59.94 ± 10.63 years; 25 males) scheduled for coronary angiography underwent RT-MCE at rest, and shortly afterward underwent gated single-photon emission computed tomography (gated-SPECT). Coronary angiography was performed within 1 week after RT-MCE in all patients. The observing indexes included the images of RT-MCE that were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the Q-Lab software. The sensitivity and specificity of RT-MCE for quantitative detection of coronary artery disease (CAD) were obtained. The receiver operator characteristic (ROC) curves were used to assess the differences of accuracy in ischemic segments with A, β and A × β respectively. The sensitivity and specificity of gated-SPECT and RT-MCE for assessment of CAD were calculated using a 4-score method. Results: A total of 513 segments among 595 segments in 35 patients were obtained. The cutoffs for A, β and A × β were 4.58, 0.64, and 2.73, and the sensitivity and specificity of quantitative RT-MCE for detection of CAD were 86.0%, 80.2%, 88.9%, and 84.1%, 64.6%, 79.9%, respectively. Meanwhile, the sensitivity and specificity of semiquantitative analysis for assessment of CAD were 66.7% and 61.8%. The ROC curve area of A and A × β was 0.91 and 0.90 in the middle segments. The ROC area of A was 0.52 in the base segments. The sensitivity and specificity of gated-SPECT for assessment of CAD were 84.8% and 82.7%, respectively. The sensitivity of multi-indexes RT-MCE increased. The sensitivity was 89.1%, 90.4%, and 96.3% by A + β, A + A × β, and β + A × β. Conclusions: Quantitative RT-MCE is an effective method for the detection of coronary artery stenosis. Quantitative RT-MCE is segmented for assessment to ischemic myocardium. RT-MCE with multi-indexes has a valuable application for assessment of CAD surpassing SPECT.

Comparative analysis of instantaneous wave-free ratio and quantitative real-time myocardial contrast echocardiography for the assessment of myocardial perfusion

“…The A × β < 2.75 ( 20 , 21 ) is the gold standard for myocardial ischemia, with the cut-off for iFR of 0.85 for the diagnosis of coronary microcirculation. The sensitivity and specificity values for iFR-based detection of myocardial ischemia were 90.7 and 89.9%, respectively.…”

“…RT-MCE is a reliable method for evaluating regional myocardial perfusion. It has been reported that MBF measurements obtained by intermittent and quantitative RT-MCE techniques are well correlated with Doppler blood flow measurements in animals and humans ( 20 , 21 ). In the present study, the correlation between iFR and MCE was compared from the perspective of myocardial perfusion.…”

“…The A × β < 2.75 (20,21) is the gold standard for myocardial ischemia, with the cut-off for iFR of 0.85 for the FIGURE 5 Receiver operator characteristic (ROC) curves on iFR vs. MCE (myocardial blood flow, MBF) results (P < 0.01). Diagonal segments are produced by ties.…”

The value of real-time myocardial contrast echocardiography for detecting coronary microcirculation function in coronary artery disease patients

“…Our previous study used RT-MCE combined with dobutamine to detect CAD and viable myocardium; however, we conducted no further study on CM function in CAD patients ( 24 , 25 ). Ikonomidis et al ( 26 ) assessed the effect of percutaneous coronary intervention in acute coronary syndrome patients by MCE.…”

Evaluation of regional myocardial perfusion in methamphetamine abusers using real-time myocardial contrast echocardiography

“…The mechanism is related to ment enables the direct assessment of global and regional myocardial structure, the degree and adequacy of microvascular perfusion as well as the presence of wall motion abnormalities [7,8]. Therefore, MCE is regarded as an ideal tool for the detection of coronary artery stenosis, assessment of myocardial viability and correct triaging of patients to revascularization at rest or/and stress [8][9][10]. However, there are few data in the literature regarding the role of this technique for assessing regional myocardial perfusion in methamphetamine abusers.…”