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CLINICAL RESEARCH: ECHOCARDIOGRAPHY

Incremental value of parametric quantitative assessment of myocardial perfusion by triggered Low-Power myocardial contrast echocardiography

Eric H. C. Yu, MD, MEd, FACC^*,*, Danny M. Skyba, PhD, Howard Leong-Poi, MD, Cairrine Sloggett, RN, RDCS^*, Michal Jamorski, RDCS^*, Rohit Garg, MSEE, R. Mark Iwanochko, MD, FACC^* and Samuel C. Siu, MD, SM, FACC^*

^* Gordon Yu Hoi Chiu Echocardiographic Laboratory, The Toronto Western Hospital, Toronto, Canada
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Philips Ultrasound, Bothell, Washington, USA

Manuscript received May 1, 2003; revised manuscript received July 28, 2003, accepted September 9, 2003.

^* Reprint requests and correspondence: Dr. Eric H. C. Yu, Toronto Western Hospital, 399 Bathurst Street, East Wing 5-559, Toronto, Ontario, Canada M5T 2S8.
eric.yu{at}uhn.on.ca

OBJECTIVES: The purpose of this study was to compare the assessment of myocardial perfusion by myocardial parametric quantification (MPQ) with technetium-99m sestamibi single-photon emission computed tomographic (SPECT) imaging in humans.

BACKGROUND: Accurate visual interpretation of myocardial contrast echocardiographic (MCE) images is qualitative and requires considerable experience. Current computer-assisted quantitative perfusion protocols are tedious and lack spatial resolution. Myocardial parametric quantification is a novel method that quantifies, color encodes, and displays perfusion data as a set of myocardial parametric images according to the relative degree of perfusion.

METHODS: Forty-six consecutive patients underwent prospective stress/rest technetium-99m sestamibi gated-SPECT imaging and MCE using intravenous Optison or Definity. Apical two- and four-chamber cine loops at rest and after dipyridamole (0.56 mg/kg) stress were acquired. For each patient, the following assessments of myocardial perfusion were performed: 1) visual cine-loop assessment (VIS); 2) MPQ assessment; and 3) combined VIS + MPQ assessment.

RESULTS: The segmental rates of agreement for myocardial perfusion with SPECT were 83%, 89%, and 92% (kappa = 0.46, 0.58, and 0.68) for VIS, MPQ, and VIS + MPQ, respectively. Similar trends were seen for the classification of the presence or absence of a moderate to severe perfusion defect, with the agreement for VIS, MPQ, and VIS + MPQ being 92%, 97%, and 97%, respectively.

CONCLUSIONS: Myocardial parametric quantification demonstrates good agreement with SPECT and incremental agreement with VIS. Analysis strategies that incorporate MPQ demonstrate better agreement with SPECT than visual analysis alone.

Abbreviations and Acronyms   CAD = coronary artery disease   LAD = left anterior descending coronary artery   MCE = myocardial contrast echocardiography   MI = mechanical index   MPQ = myocardial parametric quantification   ROI = regions of interest   SPECT = single-photon emission computed tomography   TRI = triggered replenishment imaging   VIS = visual cine-loop assessment

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