Myocardial Contrast Echocardiography Evolving as a Clinically Feasible Technique for Accurate, Rapid, and Safe Assessment of Myocardial Perfusion
The Evidence So Far
Pieter A. Dijkmans, MD*,*,
Roxy Senior, MD, PhD ,
Harald Becher, MD, PhD ,
Thomas R. Porter, MD, PhD ,
Kevin Wei, MD||,
Cees A. Visser, MD, PhD* and
Otto Kamp, MD, PhD*
* Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, United Kingdom
Department of Cardiology, John Radcliffe Hospital, Headington, Oxford, United Kingdom
Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
|| Oregon Health and Science University, Portland, Oregon.
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Figure 2 Example of adenosine stress myocardial contrast echocardiography (subsequent end-systolic frames) with region of interest for quantification the apical 3-chamber view. (A) Baseline; (B) contrast destruction; (C to H) contrast replenishment.
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Figure 4 Parametric image of apical 4-chamber view, containing information about (A) peak intensity, (B) slope of replenishment curve, (C) estimate of myocardial blood flow, and (D) quality of data.
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Figure 5 We conducted a meta-analysis of 8 studies (PubMed reference lists, restricted to English-language literature) assessing the sensitivity and specificity of myocardial contrast echocardiography (MCE) and single-photon emission computed tomography (SPECT)/dobutamine stress echocardiography (DSE) for detection of significant coronary artery disease (CAD) that were published before January 2006. The text words used were "myocardial contrast echocardiography," "single-photon emission computerized tomography," "dobutamine stress echocardiography," and "stress echocardiography." Studies were included when coronary angiography was used as gold standard and if results were analyzed on a patient-based analysis. RevMan 4.2 of the Cochrane Collaboration Group was used to calculate variance-weighted pooled difference of proportions for the differences in sensitivity and specificity between MCE and SPECT/DSE according to a random effect meta-analysis. The pooled estimates of the differences in sensitivity and specificity were 0.14 (95% confidence interval [CI] 0.09 to 0.20) and 0.03 (95% CI –0.14 to 0.21), respectively, indicating a higher sensitivity for MCE than for SPECT/DSE. No difference was found for the specificity. n/N = number of patients with CAD detected by MCE or SPECT/DSE divided by the total number of patients with CAD; RD = risk difference. * indicates DSE.
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Figure 6 Example of dobutamine stress contrast echocardiography. Reversible posterior/apical (apical 3-cv, A3C) and inferior/apical (apical 2-cv, A2C) perfusion defect during peak stress (arrows). Coronary angiography (angio) demonstrates corresponding significant stenoses in the left anterior descending, left circumflex (posteroapical defect), and right coronary arteries (inferoapical defect).
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Figure 8 Fixed septal/apical perfusion defect (arrows) with myocardial contrast echocardiography (left), single photon emission computed tomography (middle), and delayed enhancement with magnetic resonance imaging (right) after myocardial infarction.
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