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J Am Coll Cardiol, 2004; 44:2185-2191, doi:10.1016/j.jacc.2004.08.059
© 2004 by the American College of Cardiology Foundation
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CARDIAC IMAGING

Comparative accuracy of real-time myocardial contrast perfusion imaging and wall motion analysis during dobutamine stress echocardiography for the diagnosis of coronary artery disease

Abdou Elhendy, MD, PhD, FACC*, Edward L. O'Leary, MD, FACC*, Feng Xie, MD*, Anna C. McGrain, BSN, RN*, James R. Anderson, PhD{dagger} and Thomas R. Porter, MD, FACC*,*

* Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
{dagger} Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska

Manuscript received May 6, 2004; accepted August 25, 2004.

* Reprint requests and correspondence: Dr. Thomas R. Porter, 981165 Nebraska Medical Center, Omaha, Nebraska 68198-1165 (Email: trporter{at}unmc.edu).

OBJECTIVE: This study sought to compare the accuracy of myocardial contrast echocardiography (MCE) and wall motion analysis (WMA) during submaximal and peak dobutamine stress echocardiography (DSE) for the diagnosis of coronary artery disease (CAD).

BACKGROUND: The relative merits of MCE and WMA for the detection of CAD during DSE have not been studied in a large number of patients.

METHODS: We studied 170 patients who underwent dobutamine (up to 50 µg/kg/min)-atropine stress testing and coronary angiography. The WMA and MCE (using repeated boluses of Optison [Mallinckrodt, St. Louis, Missouri] or Definity [Bristol-Myers Squibb, New York, New York]) were performed at rest, at intermediate stress (65% to 75% of maximal heart rate), and at peak stress. The diagnosis of CAD (≥50% stenosis in ≥1 coronary artery) was based on reversible wall motion and perfusion abnormalities.

RESULTS: Coronary artery disease was detected in 127 (75%) patients. Sensitivity of MCE was higher than that of WMA at maximal stress (91% vs. 70%; p = 0.001) and at intermediate stress (84% vs. 20%; p = 0.0001). Specificity was lower for MCE compared with WMA (51% vs. 74%; p = 0.01). Overall accuracy was higher for MCE than for WMA (81% vs. 71%; p = 0.01). Sensitivity for detection of CAD based on abnormalities in ≥2 vascular regions was higher for MCE than for WMA (67% vs. 28%; p < 0.01).

CONCLUSIONS: The majority of inducible perfusion abnormalities occur at an intermediate phase of the stress test, without wall motion abnormalities. Myocardial contrast echocardiography provides better sensitivity than WMA, particularly in patients with submaximal stress and in identifying patients with multivessel CAD.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CI = confidence interval
  DSE = dobutamine stress echocardiography
  ECG = electrocardiogram
  LAD = left anterior descending
  LCx = left circumflex
  MCE = myocardial contrast echocardiography
  RCA = right coronary artery
  WMA = wall motion analysis




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