Abstract 371: The Feasibility and Value of Real-Time 3D Adenosine Stress Contrast Echocardiography in Patients With Suspected Coronary Artery Disease
Aim: Real-time 3D echocardiography (RT3DE) has been recently introduced in several echocardiographic applications. The aim of this study was to assess the diagnostic accuracy of myocardial perfusion assessment using contrast echocardiography during RT3D adenosine stress test with reference to angiographic findings, in detecting patients with suspected coronary artery disease (CAD).
Methods: Patients who referred to our echo lab to perform stress echocardiography, submitted to RT3D adenosine stress echocardiography, with use of echo-contrast agent (SonoVue, Bracco) for assessment of perfusion, during continuous (140 μg/kg/min) adenosine infusion for 4 minutes. Pyramidal full-volume datasets were obtained with X3–1 transducer and 3D images were digitally stored and processed off-line using PHILIPS QLAB 5.0 software (RT3DE contrast enhanced datasets were cropped to obtain sections corresponding to traditional 2D views). The 17-segment division of the left ventricle was used, with each segment being attributed as normal or abnormal perfusion. Coronary angiography was performed in all patients within one month.
Results: Thirty patients (age 62.6±11.3 years, 22 men) were enrolled, 60% had CAD, i.e. 510 segments were evaluated at rest and at peak stress. Mean heart rate before adenosine infusion was 71±4 bpm, lower than that of the end of adenosine infusion 92±3 bpm (p<0.01). The mean blood pressure value obtained just before performing the stress echo was 112±4 mmHg and at the end of adenosine infusion 120±8 mmHg, respectively (p=NS). Myocardial perfusion could be assessed, at rest, in 97%, and in 96% of segments, at peak stress, (p=NS). Analysis per patient revealed that the sensitivity, specificity and accuracy of RT3DE to detect CAD were 89%, 85% and 86%, respectively. Interobserver and intraobserver agreement for myocardial perfusion (by segment analysis) was 91% and 93%, respectively.
Conclusion: Real-time 3D adenosine stress echocardiography is a feasible and valuable technique to evaluate myocardial perfusion in patients with suspected coronary artery disease, despite existing problems with RT3DE comparatively low spatial and temporal resolution.