(Circulation. 1997;96:785-792.)
© 1997 American Heart Association, Inc.
Articles |
Detection of Coronary Artery Disease With Myocardial Contrast Echocardiography
Comparison With 99mTc-Sestamibi Single-Photon Emission Computed Tomography
From the Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, Va (S.K.); the Cardiology Department, Northwick Park Hospital, Harrow, UK (R.S., U.R., R.K., A.L.); and Molecular Biosystems, Inc, San Diego, Calif (H.D.).
Correspondence to Sanjiv Kaul, MD, Cardiovascular Division, Box 158, Medical Center, University of Virginia, Charlottesville, VA 22908. E-mail sk{at}virginia.edu
Background The purpose of this study was to determine whether myocardial contrast echocardiography (MCE) can be used to detect coronary artery disease (CAD) during rest and pharmacological stress in humans through the use of venous injections of contrast.
Methods and Results Thirty patients with known or suspected
CAD underwent MCE and 99mTc-sestamibi single-photon
emission computed tomography (SPECT) at baseline and after
dipyridamole (0.56
mg · kg-1) infusion. Ten myocardial
segments (5 each in the apical two- and four-chamber views) from the
two sets of images using both methods were scored for myocardial
perfusion as follows: 1=normal, 0.5=mildly reduced, and 0=severely
reduced. The information from baseline and
postdipyridamole images was then used to determine
whether an abnormal segment was irreversible (similar abnormal
perfusion at baseline and after dipyridamole) or
reversible (perfusion better at baseline compared with after
dipyridamole). Concordance between segmental scores was
92% (
=.99) for both methods. Concordance between normal perfusion
and reversible or irreversible segmental defects was 90% (=.80).
Agreement between the two methods for each of the three vascular
territories in each patient was 90% (=.77), while agreement for the
presence or absence of CAD in each patient was 86% (=.86). In the 4
patients with disagreement, the perfusion scores were 0.5 for SPECT and
1.0 for MCE.
Conclusions This study shows that MCE, with venous injection of contrast, can define the presence of CAD during rest and pharmacological stress. The location of perfusion abnormalities and their physiologic relevance (reversible or irreversible) by MCE is similar to that provided by SPECT. MCE, therefore, holds promise for the noninvasive assessment of myocardial perfusion in humans.
Key Words: echocardiography • coronary disease • tomography • imaging
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