CLINICAL RESEARCH
Myocardial Contrast Echocardiography for the Detection of Coronary Artery Stenosis
A Prospective Multicenter Study in Comparison With Single-Photon Emission Computed Tomography
Paramjit Jeetley, MBChB, MRCP*,
Michael Hickman, MB, BS, MRCP*,
Otto Kamp, MD ,
Roberto M. Lang, MD ,
James D. Thomas, MD ,
Mani A. Vannan, MBBS||,
Jean Louis Vanoverschelde, MD¶,
Poll A. van der Wouw, MD# and
Roxy Senior, MD, DM, FRCP*,*
* Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, United Kingdom
VU University Medical Center, Amsterdam, the Netherlands
# Onzw Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
University of Chicago, Chicago, Illinois
Cleveland Clinic Foundation, Cleveland, Ohio
|| University of California at Irvine, Irvine, California
¶ University Hospital Saint Luc, Brussels, Belgium
Manuscript received May 17, 2005;
revised manuscript received August 1, 2005,
accepted August 9, 2005.
* Reprint requests and correspondence: Dr. Roxy Senior, Consultant Cardiologist and Director of Cardiac Research, Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ United Kingdom (Email: roxy.senior{at}virgin.net).
OBJECTIVES: The purpose of this study was to compare myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) for the detection of significant coronary artery disease (CAD) in patients with symptoms suggestive of CAD.
BACKGROUND: Single-photon emission computed tomography is a well-established method of assessing patients with CAD. Myocardial contrast echocardiography is a new technique allowing bedside assessment of myocardial perfusion. We hypothesized that MCE was comparable to SPECT in the assessment of patients with known or suspected CAD.
METHODS: A total of 123 patients scheduled for coronary angiography underwent intermediate (mechanical index 0.5) triggered replenishment MCE and SPECT imaging at rest and after vasodilator stress. Coronary angiography was performed within four weeks of stress imaging.
RESULTS: In total, 96 of 123 (78%) patients demonstrated CAD (stenosis  50%). There was no difference in the sensitivity of MCE compared with SPECT in the detection of CAD (84% vs. 82%; p = NS), and both demonstrated similar specificity (56% vs. 52%, respectively). In patients with multivessel disease, MCE and SPECT also demonstrated similar sensitivity (91% and 88%, respectively) for the detection of CAD. Agreement between MCE and SPECT for the presence or absence of CAD was 73%.
CONCLUSIONS: Myocardial contrast echocardiography is comparable to SPECT in the detection of CAD not only on a patient basis but also in the localization of disease by vascular territory in a relatively high-risk population.
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | CAD = coronary artery disease | | LCx = left circumflex artery | | MCE = myocardial contrast echocardiography | | MVD = multivessel disease | | RCA = right coronary artery | | SPECT = single-photon emission computed tomography |
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