Head to head comparisons of two modalities of perfusion adenosine stress echocardiography with simultaneous SPECT

Petri Gudmundsson,Lennart Ljunggren,Reidar Winter,Mariusz Kitlinski,Ola Thorsson,Ronnie B Willenheimer,Magnus Dencker,Kambiz Shahgaldi

doi:10.1186/1476-7120-7-19

Abstract

BackgroundReal-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia. We compared two different types of RTP power modulation techniques, angiomode (AM) and high-resolution grayscale (HR), with 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia.MethodsPatients with known or suspected coronary artery disease (CAD), admitted to SPECT, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using AM and HR during Sonovue® infusion, before and throughout the adenosine stress, also used for SPECT. Analysis of myocardial perfusion and wall motion by RTP-ASE were done for AM and HR at different time points, blinded to one another and to SPECT. Each segment was attributed to one of the three main coronary vessel areas of interest.ResultsIn 50 patients, 150 coronary areas were analyzed by SPECT and RTP-ASE AM and HR. SPECT showed evidence of ischemia in 13 out of 50 patients. There was no significant difference between AM and HR in detecting ischemia (p = 0.08). The agreement for AM and HR, compared to SPECT, was 93% and 96%, with Kappa values of 0.67 and 0.75, respectively (p < 0.001).ConclusionThere was no significant difference between AM and HR in correctly detecting myocardial ischemia as judged by SPECT. This suggests that different types of RTP modalities give comparable data during RTP-ASE in patients with known or suspected CAD.

Highlights

Real-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia
Adenosine stress echocardiography (ASE) is a less expensive technique as compared to single-photon emission computed tomography (SPECT) and more tolerable compared to dobutamine atropine stress echocardiography (DSE) for the assessment of patients with suspected coronary artery disease
The results from the present study show overall similarities, but some differences, no statistically significant, between the two different types of RTP power modulation techniques, data derived from different techniques for RTP-ASE are reasonably interchangeable

Summary

Introduction

Real-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia. Exercise ECG is considered the first-line technique for assessment of ischaemia, whereas single-photon emission computed tomography (SPECT) or dobutamine atropine stress echocardiography (DSE) are suggested when exercise ECG are non-diagnostic or non-interpretable [3,4] Both SPECT and DSE are more accurate methods than exercise ECG, more expensive [4,5,6,7]. The use of second-generation contrast agents in myocardial contrast echocardiography enables assessment of myocardial perfusion during ECG triggered image acquisition echocardiography with high mechanical index, i.e. harmonic power Doppler. This technique is technically demanding, and has limitations, e.g. because no wall motion evaluation is possible

Objectives

Methods

Results

Discussion

Conclusion