Abstract
AimsReal-time perfusion (RTP) adenosine stress echocardiography (ASE) can be used to visually evaluate myocardial ischaemia. The RTP power modulation technique angio-mode (AM), provides images for off-line perfusion quantification using Qontrast® software, generating values of peak signal intensity (A), myocardial blood flow velocity (β) and myocardial blood flow (Axβ). By comparing rest and stress values, their respective reserve values (A-r, β-r, Axβ-r) are generated. We evaluated myocardial ischaemia by RTP-ASE Qontrast® quantification, compared to visual perfusion evaluation with 99mTc-tetrofosmin single-photon emission computed tomography (SPECT).Methods and ResultsPatients admitted to SPECT underwent RTP-ASE (SONOS 5500) using AM during Sonovue® infusion, before and throughout adenosine stress, also used for SPECT. Visual myocardial perfusion and wall motion analysis, and Qontrast® quantification, were blindly compared to one another and to SPECT, at different time points off-line.We analyzed 201 coronary territories (left anterior descendent [LAD], left circumflex [LCx] and right coronary [RCA] artery territories) in 67 patients. SPECT showed ischaemia in 18 patients and 19 territories. Receiver operator characteristics and kappa values showed significant agreement with SPECT only for β-r and Axβ-r in all segments: area under the curve 0.678 and 0.665; P < 0.001 and < 0.01, respectively. The closest agreements were seen in the LAD territory: kappa 0.442 for both β-r and Axβ-r; P < 0.01. Visual evaluation of ischaemia showed good agreement with SPECT: accuracy 93%; kappa 0.67; P < 0.001; without non-interpretable territories.ConclusionIn this agreement study with SPECT, RTP-ASE Qontrast® quantification of myocardial ischaemia was less accurate and less feasible than visual evaluation and needs further development to be clinically useful.
Highlights
In low risk patients with suspected myocardial ischaemia, evaluation of ischaemia is generally recommended for optimal care and treatment [1,2]
Patients admitted to single-photon emission computed tomography (SPECT) underwent real time myocardial perfusion (RTP)-Adenosine stress echocardiography (ASE) (SONOS 5500) using AM during Sonovue® infusion, before and throughout adenosine stress, used for SPECT
The closest agreements were seen in the left anterior descending (LAD) territory: kappa 0.442 for both β-r and Axβr; P < 0.01
Summary
In low risk patients with suspected myocardial ischaemia, evaluation of ischaemia is generally recommended for optimal care and treatment [1,2]. 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]. Both SPECT and DSE are well established and more accurate methods than exercise ECG [4,5,6,7], more expensive. RTP combined with ASE has shown promising results in evaluating myocardial ischaemia in different patient populations and settings [10,11,12,13,14,15,16,17,18]. If a quantitative echocardiographic technique were to show equivalent results to SPECT in detecting myocardial ischaemia, it could be an alternative method, more available and without radiation compared to SPECT, more tolerable and swifter than DSE, and more accurate than exercise ECG
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
