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CLINICAL STUDY: STRESS TESTING

Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography: comparison with single photon emission computed tomography

Sarah Shimoni, MD^*, William A. Zoghbi, MD, FACC^*, Feng Xie, MD, David Kricsfeld, BS, Sherif Iskander, MD^*, Lisa Gobar, MD, Issam A. Mikati, MD^*, John Abukhalil, RT^*, Mario S. Verani, MD, FACC^*, Edward L. O’Leary, MD, FACC and Thomas R. Porter, MD, FACC

^* Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA

Manuscript received June 2, 2000; revised manuscript received October 20, 2000, accepted November 22, 2000.

Reprint requests and correspondence: Dr. William A. Zoghbi, Echocardiography Research, Baylor College of Medicine, 6550 Fannin, SM-677, Houston, Texas 77030
wzoghbi{at}bcm.tmc.edu

OBJECTIVES

We sought to determine the feasibility and accuracy of real-time imaging of myocardial contrast echocardiography (MCE) in detecting myocardial perfusion defects during exercise echocardiography compared with radionuclide tomography.

BACKGROUND

Ultrasound imaging at a low mechanical index and frame rate (10 to 20 Hz) after intravenous injections of perfluorocarbon containing microbubbles has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously and in real time.

METHODS

One hundred consecutive patients with intermediate-to-high probability of coronary artery disease underwent treadmill (n = 50) or supine bicycle (n = 50) exercise echocardiography. Segmental perfusion with MCE and WM were assessed in real time before and at peak exercise using low mechanical index (0.3) and frame rates of 10 to 20 Hz after 0.3 ml bolus injections of intravenous Optison (Mallinckrodt Inc., San Diego, California). All patients had a dual isotope (rest thallium-201, stress sestamibi) study performed during the same exercise session, and 44 patients had subsequent quantitative coronary angiography.

RESULTS

In the 100 patients, agreement between MCE and single photon emission computed tomography (SPECT) was 76%, while it was 88% between MCE and WM assessment. Compared with quantitative angiography, sensitivity of MCE, SPECT and WM was comparable (75%), with a specificity ranging from 81% to 100%. The combination of MCE and WM had the best balance between sensitivity and specificity (86% and 88%, respectively) with the highest accuracy (86%).

CONCLUSIONS

The real-time assessment of myocardial perfusion during exercise stress echocardiography can be achieved with imaging at low mechanical index and frame rates. The combination of WM and MCE correlates well with SPECT and is a promising important addition to conventional stress echocardiography.

Abbreviations and Acronyms   AII = accelerated intermittent imaging   CAD = coronary artery disease   CX = circumflex   LAD = left anterior descending   MCE = myocardial contrast echocardiography   RCA = right coronary artery   SPECT = single photon emission computed tomography   WM = wall motion

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