Value Of Myocardial Contrast Echocardiography Research Articles

Value of Myocardial Contrast Echocardiography in Detecting Coronary Microcirculatory Dysfunction in Ischemia With Non-obstructive Coronary Artery Disease

The aim of this study was to evaluate the value of myocardial contrast echocardiography (MCE) in detecting coronary microcirculation function dysfunction in ischemia with non-obstructive coronary artery (INOCA) disease. Twenty-one patients with a clinical diagnosis of INOCA were admitted to the First Affiliated Hospital of Xinjiang Medical University because of chest pain. All participants underwent MCE and [18F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography myocardial metabolic imaging. With the results of FDG PET taken as the gold standard, all myocardial segments were divided into a normal control group and a coronary artery microcirculation dysfunction (CMCD) group. We used MCE to measure myocardial perfusion parameters, including the ascending slope (β), time to peak (TTP), A and A×β. The receiver operating characteristic (ROC) curves of β, TTP, A and A×β were calculated to evaluate the diagnostic value of MCE for CMCD. A total of 122 and 218 segments were investigated in the CMCD and control groups, respectively. On the basis of the statistical analysis of the MCE parameters of the two groups, the myocardial perfusion parameters β, A and A×β of all segments in the CMCD group decreased, and the TTP in the basal segment of the CMCD group was longer than that of the normal control group (all p values <0.05). On the basis of analysis of the ROC curve, β had the highest diagnostic efficiency in the middle segment. This study found that MCE is valuable in the diagnosis of non-obstructive coronary artery complicated by CMCD.

Long-Term Prognostic Value of Myocardial Viability by Myocardial Contrast Echocardiography in Patients after Acute Myocardial Infarction: A Systematic Review and Meta-Analysis.

Background and Objectives: According to recent guidelines, myocardial contrast echocardiography (MCE) is recommended for detecting residual myocardial viability (MV). However, the long-term prognostic value of MV as assessed by MCE in identifying major adverse cardiac events (MACE) after acute myocardial infarction (AMI) remains undefined. Materials and Methods: We searched multiple databases, including PubMed, EMBASE, and Web of Science for studies on the prognostic value of MCE for clinical outcomes in AMI patients. The primary endpoints were MACEs during follow-up. Six studies that evaluated a total of 536 patients with a mean follow-up of 36.8 months were reviewed. Results: The pooled sensitivity and specificity of MCE for predicting MACEs were 0.80 and 0.78, respectively, and the summary operating receiver characteristics achieved an area under the curve of 0.84. The pooled relative risks demonstrated that the MV evaluated by MCE after AMI was correlated with a high risk for total cardiac events (pooled relative risk: 2.07; 95% confidence interval: 1.28–3.37) and cardiac death (pooled relative risk: 2.48; 95% confidence interval: 1.03–5.96). MV evaluated by MCE was a highly independent predictor of total cardiac events (pooled hazard ratio: 2.09, 95% confidence interval: 1.14–3.81) in patients after AMI. Conclusions: Residual MV evaluated by MCE may be an effective long-term prognostic tool for predicting MACE in patients after AMI that can provide moderate predictive accuracy. The assessment of MV by MCE may become an alternative technique with the potential to rapidly provide important information for improving long-term risk stratification in patients after AMI, at the bedside in clinical practice, especially for patients who cannot tolerate prolonged examinations. The PROSPERO registration number is CRD42020167565.

The application of myocardial contrast echocardiography in assessing microcirculation perfusion in patients with acute myocardial infarction after PCI

BackgroundTo evaluate the myocardial microcirculation perfusion of patients with acute ST-segment elevation myocardial infarction (STEMI) with a different index of microcirculatory resistance (IMR) after percutaneous coronary intervention (PCI) by myocardial contrast echocardiography (MCE) and analyse the value of MCE in predicting myocardial perfusion after PCI.MethodsFifty-six patients with acute STEMI who underwent an emergency PCI were selected from October 2018 to October 2019 in our hospital. According to the IMR values measured during PCI treatment, the patients were divided into three groups. Traditional ultrasound and MCE were performed one week after PCI. The left ventricular ejection fraction (LVEF), ventricular wall motion score index (WMSI), A value, β value and A × β value (which refers to the patient’s myocardial blood flow) were measured. The receiver operating characteristic curve was drawn to evaluate the effectiveness of the MCE parameters in the diagnosis of myocardial microcirculation perfusion disorders.ResultsThe results showed that there was no significant difference in the LVEF among the groups. The WMSI in Group 3 was statistically different from that in Groups 1 and 2 (P < 0.05), but there was no statistically significant difference in the WMSI between Groups 1 and 2. Among the three groups, the A value, β value and A × β value were significantly different (P < 0.05). According to Spearman’s correlation analysis, the MCE quantitative parameters (i.e. the A value, β value and A × β value) were negatively correlated with the IMR value (r = −0.523, −0.471, −0.577, P < 0.01).ConclusionsThe A value, β value and A × β value were negatively correlated with the IMR value. Furthermore, MCE could be used to observe the myocardial perfusion in patients with acute STEMI after PCI and may be one of the indicators used to accurately evaluate myocardial microcirculation.

Evaluation of myocardial perfusion and systolic function in patients with coronary heart disease by myocardial contrast echocardiography and 2-dimensional speckle tracking imaging.

The high prevalence and high fatality rate of coronary heart disease seriously endanger the safety of human life. The key to its treatment is to restore the perfusion of the narrowed coronary arteries as soon as possible. Two-dimensional echocardiography is limited for assessment of postoperative myocardial function. Myocardial contrast echocardiography (MCE) and 2-dimensional speckle tracking imaging (2D-STI) possess good value in assessing myocardial perfusion and systolic function. We used MCE and 2D-STI to explore the changes of myocardial perfusion and systolic function after percutaneous coronary intervention (PCI) in patients with coronary heart disease, and to evaluate the clinical value of MCE and 2D-STI. Twenty patients with coronary heart disease undergoing PCI were selected. MCE was performed before and one day after PCI, and 2D-STI and conventional ultrasound were performed before and a month after PCI. The recovery of left ventricular wall motion was used as a standard to evaluate the ability of MCE semi-quantitative analysis and to predict the recovery of myocardial segment motion. The quantitative value of MCE (signal intensity of contrast medium in plateau phase, slope of curve, and their product) one day after PCI and the contractile function of one month after PCI were significantly improved (all P<0.05). There were 90 myocardial segments with abnormal motion dominated by the coronary artery with stent implantation before PCI, and 54 segments recovered 1 month after PCI. The sensitivity and specificity of MCE score ≤2 to predict recoverable wall motion were 93% and 53%, respectively. MCE and 2D-STI can evaluate the improvement of myocardial perfusion and systolic function in patients with coronary heart disease after PCI, and MCE semi-quantitative analysis can effectively predict the ability of ventricular wall recovery.

Assessment of myocardial viability by myocardial contrast echocardiography: current perspectives.

The current guidelines recommend the use of myocardial contrast echocardiography (MCE) to assess myocardial viability. There are two clinical scenarios where detection of myocardial viability has clinical significance: in ischemic cardiomyopathy and following acute myocardial infarction with significant left ventricular dysfunction. Myocardial contrast echocardiography (MCE), which utilizes microbubbles can assess the integrity of the microvasculature, which sustains myocardial viability in real time and can hence rapidly provide information on myocardial viability at the bedside without ionizing radiation. We discuss the value of MCE to predict myocardial viability through the detection of the integrity of myocardial microvasculature, the newer evidences behind the MCE-derived coronary flow reserve and use of MCE postmyocardial infarction to detect no-reflow. Newer studies have also demonstrated the comparable sensitivities and specificities of MCE to single photon-emission computed tomography (SPECT), cardiac myocardial resonance imaging and PET for the detection of myocardial viability. Ample evidence now exist that supports the routine use of MCE for the detection of viability as laid down in recent guidelines.

Myocardial contrast echocardiography in mice: technical and physiological aspects.

Myocardial contrast echocardiography (MCE) offers the opportunity to study myocardial perfusion defects in mice in detail. The value of MCE compared with single-photon emission computed tomography, positron emission tomography, and computed tomography consists of high spatial resolution, the possibility of quantification of blood volume, and relatively low costs. Nevertheless, a number of technical and physiological aspects should be considered to ensure reproducibility among research groups. The aim of this overview is to describe technical aspects of MCE and the physiological parameters that influence myocardial perfusion data obtained with this technique. First, technical aspects of MCE discussed in this technical review are logarithmic compression of ultrasound data by ultrasound systems, saturation of the contrast signal, and acquisition of images during different phases of the cardiac cycle. Second, physiological aspects of myocardial perfusion that are affected by the experimental design are discussed, including the anesthesia regimen, systemic cardiovascular effects of vasoactive agents used, and fluctuations in body temperature that alter myocardial perfusion. When these technical and physiological aspects of MCE are taken into account and adequately standardized, MCE is an easily accessible technique for mice that can be used to study the control of myocardial perfusion by a wide range of factors.

107 The long term prognostic value of dipyridamole stress myocardial contrast echocardiography in comparison with single photon emission tomography in patients with known or suspected coronary artery disease

BackgroundSingle photon emission computed tomography (SPECT) is a well-established method to evaluate patients with coronary artery disease (CAD). Myocardial contrast echocardiography (MCE) is an imaging technique that allows assessment of...

Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis

Myocardial perfusion (MP) imaging during stress myocardial contrast echocardiography (MCE) improves the detection of coronary artery disease (CAD). However, its prognostic value to predict cardiac events in patients with known or suspected CAD is still undefined. A search was conducted for single- or multicenter prospective studies that evaluated the prognostic value of stress MCE in patients with known or suspected CAD. A database search was performed through June 2015. Effect sizes of relative risk ratios (RRs) with their corresponding 95% CIs were used to evaluate the association between the occurrence of total cardiac events (cardiac death, nonfatal myocardial infarction, coronary revascularization) and hard cardiac events (cardiac death and nonfatal myocardial infarction) in subjects with normal and abnormal MP measured by MCE. The Cochran Q statistic and the I2 statistic were used to assess heterogeneity. A comprehensive literature search of the MEDLINE, Google Scholar, Cochrane, and Embase databases identified 11 studies enrolling a total of 4,045 patients. The overall analysis of RRs revealed that patients with abnormal MP were at higher risk for total cardiac events compared with patients with normal MP (RR, 5.58; 95% CI, 3.64-8.57; P<.001), with low heterogeneity among trials (I2=48.15%, Q=7.71, P=.103). Similarly, patients with abnormal MP were at higher risk for hard cardiac events compared with patients with normal MP (RR, 4.99; 95% CI, 1.75-14.32; P=.003), with significant heterogeneity among trials (I2=81.48%, Q=21.59, P<.001). The results of this meta-analysis suggest that MP assessment using stress MCE is an effective prognostic tool for predicting the occurrence of cardiac events in patients with known or suspected CAD.

144 The Incremental Prognostic Value of Myocardial Contrast Echocardiography in Clinical Practice: Follow-up Results from the Impact of Myocardial Perfusion Assessment in Clinical Tests of Stress Echocardiography (IMPACT-SE) Study

BackgroundThe prognostic value of myocardial perfusion (MP), assessed during stress echocardiography (SE) by myocardial contrast echocardiography (MCE), has been shown in research studies but is untested in a ‘real-world’ clinical...

Simultaneous evaluation of perfusion by myocardial contrast echocardiography is incrementally beneficial beyond wall motion analysis only: results from a real-world stress echocardiography service

Purpose: The diagnostic accuracy of myocardial contrast echocardiography (MCE), performed during stress echocardiography (SE), for evaluation of known or suspected coronary artery disease (CAD), has been proven in research studies. However, the feasibility and value of MCE incorporated into a real-world clinical SE service are unknown. This prospective study thus aimed to determine the clinical role of MCE. Methods: All patients had been referred for SE on clinical grounds. We performed MCE during SE, using a continuous infusion of Sonovue contrast, in patients undergoing pharmacological stress and those performing exercise in whom we suspected a high workload or target heart rate may not be attained. We documented clinical and SE variables and value of MCE to the reporting cardiologist, pre-defined as: incremental benefit over wall motion (WM), more confidence with WM, no benefit over WM or uninterpretable MCE images. All studies were analysed by the performing cardiologist and an expert. We examined agreement between WM and MCE data and angiography findings, where significant CAD was defined as ≥50% stenosis. Results: Over 21months, 220 patients underwent MCE by 8 operators. Mean age was 66yrs & 74% were men. MCE demonstrated excellent feasibility, with diagnostic images in 94% studies. Mean contrast use was 2.8 vials/study. MCE provided incremental benefit over WM analysis in 56 (25%) cases, gave more confidence with WM in 49 (22%) cases, had no added value over WM in 102 (47%) cases and was uninterpretable in 13 (6%) cases. Of the 60 patients with confirmed CAD at angiography, MCE detected more patients with LAD disease compared to WM only (65% vs. 53%, p 0.02) and a greater ischaemic burden than WM on a per-patient basis (median segments 5 [MCE] vs. 4 [WM], p <0.001) and in both the anterior (3 vs. 1 segments, p<0.001) and posterior (4 vs. 2 segments, p<0.001) coronary circulation. Multivessel disease (MVD – LAD + LCx/RCA disease) was correctly detected by MCE in 26/34 (76%) patients but only 19/34 (56%) patients by WM (p 0.02); in MVD patients, MCE also identified a significantly greater ischaemic burden than WM (7 vs. 5 segments, p<0.001) and, furthermore, identified LAD disease missed by WM in >50% MVD patients. Conclusion: MCE is feasible by multiple operators when incorporated into a clinical SE service. MCE data provides the reporting cardiologist with incremental benefit or greater confidence in a significant proportion of cases. MCE is more sensitive than WM for detecting flow-limiting LAD disease, correctly predicting presence of MVD and identifies a greater burden of ischaemia.

120 INCORPORATION OF MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY INTO A CLINICAL STRESS ECHOCARDIOGRAPHY SERVICE IS FEASIBLE AND IMPROVES THE DIAGNOSTIC ACCURACY BEYOND THAT PROVIDED BY WALL MOTION ASSESSMENT ONLY

Introduction Myocardial contrast echocardiography (MCE) has been shown in clinical trials to improve the diagnostic accuracy of stress echocardiography (SE). However, the feasibility and value of MCE incorporated into a clinical SE service in a ‘real-world’ setting is unknown. Hypothesis We hypothesised that evaluation of myocardial perfusion—as well as wall motion—is feasible and improves the diagnostic accuracy of the clinical SE service in our centre. Methods We performed MCE during SE in all patients undergoing pharmacological stress and patients undergoing treadmill exercise whom we suspected may not attain a high workload or target heart rate. We documented prospectively demographic variables, reason for referral, stress modality, amount of contrast used and value of MCE, which was assigned to one of four pre-determined categories: incremental benefit over wall motion (WM) analysis, more confidence with WM analysis, no benefit over WM analysis or other (eg, uninterpretable MCE images). All MCE studies were analysed by the performing cardiologist together with an expert reader. Results Over a 21 month period, 893 patients underwent SE and 220 (25%) of these also underwent MCE by 8 different operators. Mean (±SD) age was 64±13 years. MCE demonstrated excellent feasibility, with diagnostic images obtained in 207/220 (94%) studies. Mean contrast use was 2.8 vials per study. MCE data provided incremental benefit over WM analysis in 56 (25%) cases, gave greater confidence with WM analysis in 46 (21%) cases, had no added value over WM analysis in 103 (47%) cases and was uninterpretable in 13 (6%) cases. In patients with inducible ischaemia, mean (±SD) number of ischaemic segments was 3.8±3.2 by WM and 5.2±3.3 by MCE (p<0.001). Of the 78/220 patients that underwent angiography, perfusion data agreed with angiographic findings in 66 (85%) cases. Amongst these patients, agreement between MCE and angiography findings were 26/29 (90%) and 20/26 (77%) in those in whom MCE data was of incremental benefit and added confidence to wall motion assessment, respectively. Conclusions MCE, performed by multiple operators, is feasible when incorporated into a clinical SE service. MCE data is either of incremental benefit over WM analysis or gives more confidence with WM analysis in a significant proportion (approximately 50%) of cases.[⇓][1] ![Figure 1][2]</img> Figure 1 [1]: #F1 [2]: pending:yes

Bolus injection or continuous infusion for the assessment of myocardial blood flow during perfusion stress echocardiography?

We read the recent article by Wejner-Mik et al. 1 in the Journal with great interest and we congratulate them on their study which re-emphasizes both the clinical value of myocardial contrast echocardiography (MCE) and specifically the prognostic value of dipyridamole MCE. Both real-time and triggered imaging techniques were used, highlighting the robust nature of each method. We wish to highlight certain methodological aspects which may be of use in planning future studies. First, the contrast agent (Optison) was administered by repeated bolus injections rather than a continuous intravenous infusion. The pioneering …

Potential value of myocardial contrast echocardiography for the detection of myocardial fibrosis in hypertrophic cardiomyopathy

MOTS CLES Echocardiographie de contraste ; Imagerie par We report the case of a 37-year-old man with hypertrophic cardiomyopathy. Echocardiography showed a left ventricular hypertrophy (LVH) on the septal area (25 mm), without intraventricular obstruction or systolic anterior motion of the mitral valve. Myocardial contrast echocardiography showed an unusual capture of the contrast in the anteroseptal wall of the left ventricle, 5 minutes after injection of Sonovue® (Bracco Diagnostics, Inc., Princeton, NJ, USA; Fig. 1). Two weeks later, magnetic resonance imaging (MRI) was performed to confirm the LVH predominantly on the septal area (25 mm). Myocardial mass was 335 g. Delayed enhancement MRI studies (10 minutes after gadolinium injection) showed a delay-enhancement on the septal wall of the left ventricle, with an excellent topographic match with the abnormal contrast retention seen on echocardiography. The late enhancement was patchy and located predominantly in the subendocardium and not in the intramyocardium, which is more usual in LVH (Fig. 2). To rule out ischaemic cardiopathy, cardiac computed tomography was performed, which was normal. Delayed enhancement MRI studies can show late myocardial enhancement in hyper-

The value of myocardial contrast echocardiography in evaluating the relationship between myocardial perfusion and cardiac resynchronisation therapy: an animal study

ObjectiveTo establish an animal model of heart failure and cardiac resynchronisation therapy (CRT) after myocardial infarction. Myocardial contrast echocardiography (MCE) was used to quantitatively analyse the myocardial perfusion in order...

Role of Noninvasive Imaging in the Diagnosis of Cardiac Allograft Vasculopathy

Cardiac allograft vasculopathy (CAV) is common, with a prevalence of 52% at 10 years after transplantation, and represents a leading cause of death beyond the first year, responsible for approximately 15% of deaths annually.1 It is characterized by diffuse and concentric intimal proliferation, typically involving the intramural as well as epicardial coronary arteries. Its diagnosis is difficult to establish clinically because of denervation of the transplanted heart. Consequently, it presents late with silent myocardial infarction, progressive heart failure, or arrhythmic sudden death.2 Screening is therefore required for its early detection. Although coronary intravascular ultrasound (IVUS) is considered the gold-standard technique for detecting the anatomic features of CAV (Table 1), its broad clinical use in this context is limited by cost and lack of widespread expertise, and its evaluation is limited to epicardial vessels.3 Coronary angiography, performed annually or biannually, remains the most common clinical screening method.4 However, because of the diffuse nature of CAV with a lack of normal reference segments and the relatively late occurring luminal narrowing, the sensitivity of angiography is as low as 30% when compared with IVUS (Figure 1).5 As a result, complications frequently occur before disease is evident angiographically.6 Furthermore, angiography is associated with significant albeit uncommon complications (overall complication rate, 7.4/1000 procedures, including rates of 0.65/1000, 1.6/1000, and 0.72/1000 for cerebrovascular accidents, vascular complications, and death, respectively), is disliked by transplant recipients, is costly, and repeated studies are associated with an important cumulative radiation dose.7 View this table: Table 1. Stanford Classification of CAV Severity on IVUS Figure 1. Invasive assessment of cardiac allograft vasculopathy (CAV) in a patient with severe disease, highlighting the limited sensitivity of conventional coronary angiography. Although no left anterior descending (LAD) flow-limiting stenoses are seen on angiography ( A ), intravascular ultrasound ( B ) shows significant intimal thickening, measuring up to …

Long-term prognostic value of dipyridamole stress myocardial contrast echocardiography

The aim of this prospective study was to determine long-term prognostic value of myocardial contrast echocardiography (MCE) combined with high-dose dipyridamole stress echocardiography (DSE) in patients undergoing diagnostic work-up for stable coronary artery disease (CAD). A total of 202 consecutive patients (67% males, age 57±8 years) with suspected or known stable CAD scheduled for coronary angiography underwent high-dose dipyridamole/atropine stress echocardiography (dipyridamole 0.84 mg/kg, iv; atropine up to 1 mg, iv) with MCE at baseline and peak stress. In 102 patients MCE was performed using electrocardiographic-triggered end-systolic harmonic imaging and in 100 patients using real-time MCE. Contrast enhancement was obtained by repeated iv boluses of contrast and was visually scored in 18 segments by consensus of 2 experienced observers. All patients completed prospective follow-up regarding major adverse cardiovascular events (cardiac mortality, revascularization, infarction and unstable angina) for a mean period of 32±11 months (range: 1-89 months). The prognostic value of inducible wall motion abnormalities (WMA) and perfusion defects (PD) was then analysed. CAD defined as ≥70% stenosis was found in 152 patients (75%). During follow-up major adverse cardiovascular events (MACE) occurred in 109 (54%) patients (10 deaths, 16 infarctions, 83 revascularizations). The presence of inducible WMA in DSE was associated with high risk of MACE [hazard ratio (HR): 5.4; 95% CI: 3.64-8.05, P<0.0001]. Cardiovascular complications were best predicted by the presence of any inducible abnormality-PD or WMA (HR: 6.1; 95% CI: 4.1-9.1, P<0.0001). Stress MCE is highly predictive of cardiovascular events in patients with suspected or known CAD in long-term follow-up.

Perfusion defects on real-time myocardial contrast echocardiography predict higher mortality in patients with end-stage renal disease – A 3-year follow-up

Aim: The aim of this study was to assess the prognostic significance of myocardial contrast echocardiography (MCE) in patients with end-stage renal disease (ESRD) on a 3-year follow-up and to compare the value of MCE with demographic, clinical, and laboratory parameters. Methods: Fifty-eight ESRD patients on regular dialysis were prospectively screened for coronary artery disease (CAD) using perfusion assessment on real-time MCE. We analyzed the following end points during the 3-year follow-up: death, cardiovascular complications, and combined end point, which consisted of adverse cardiac events mentioned above. All features were compared between the two groups with and without perfusion disturbances on MCE. Results: No adverse events related to MCE administration have been observed. Twenty-seven (47%) patients with ESRD demonstrated perfusion defects on MCE. The patients with perfusion defects on MCE comparison with those without perfusion disturbances were older (p = 0.008) and had lower ejection fraction (EF) (p = 0.0001) and higher wall motion index (WMSI) (p = 0.0001). After the 3-year follow-up, the incidence of death (p = 0.00018), cardiovascular end points, revascularizations [both percutaneous coronary intervention (PCI) and coronary artery bypass grafts (CABG) p = 0.0016 and p = 0.004, respectively], and composite end point (p = 0.0015) was significantly higher in patients with perfusion defect on MCE. Conclusions: In patients with ESRD, MCE appears to be a safe and useful tool for risk stratification. MCE facilitates decision for coronary angiography.

Myocardial Contrast Echocardiography Enhances Long-Term Prognostic Value of Supine Bicycle Stress Two-Dimensional Echocardiography

The aim of this study was to determine the incremental prognostic value of myocardial contrast echocardiography (MCE) over two-dimensional echocardiography (2DE) in patients undergoing supine bicycle stress. Eighty-four patients with known or suspected coronary artery disease who underwent supine bicycle stress with 2DE and MCE (mean age, 58.5 +/- 9.7 years; 68 men) were followed up for 48.3 +/- 8.9 months for cardiac death (n = 1), nonfatal myocardial infarction (n = 9), and revascularization (n = 20). In sequential Cox models, the predictive power of the clinical model was strengthened by 2DE (chi(2) = 7.73 vs 12.92, P = .02) and further improved by MCE (chi(2) = 19.04, P = .01). On multivariate analysis, the only independent follow-up event predictor was ischemia on MCE (hazard ratio, 6.79; 95% confidence interval, 2.02-22.82; P = .001). Among patients with normal results on 2DE, those with normal results on MCE had greater 4.5-year event-free survival than those with abnormal results on MCE (93% vs 69%, P = .01). MCE enhances the predictive power of supine bicycle stress 2DE and allows the risk stratification of patients with normal results on 2DE.

Detection of single‐vessel coronary artery disease by dipyridamole stress echocardiography: no longer a problem?

We aimed to evaluate whether addition of myocardial contrast echocardiography (MCE) perfusion data improves the sensitivity of stress echocardiography for detection of single-vessel coronary artery disease (svCAD) and to compare the diagnostic value of MCE and single-photon emission computed tomography (SPECT) for detection of svCAD. One hundred and three patients with suspected or known stable CAD underwent dipyridamole (0.84 mg kg(-1) intravenously over 4 min)-atropine (up to 1 mg intravenously) stress echocardiography combined with MCE. Wall motion abnormalities (WMA) and perfusion defects were assessed visually. Presence of CAD was detected by coronary angiography. Single-vessel coronary artery disease defined as >or=70% stenosis was detected in 30% of patients, whereas 26% of patients had svCAD defined as >or=50% stenosis. Presence of inducible WMA had 35% and 26% sensitivity for detection of svCAD defined as >or=70% and >or=50% stenosis, respectively. Concomitant evaluation of MCE increased the sensitivity to 74% (P = 0.005) and 56% (P = 0.053), respectively, using any inducible abnormality (WMA or perfusion defects) as a criterion. Presence of any (inducible or fixed) WMA had 77% and 59% sensitivity for detection of svCAD defined as >or=70% and >or=50% stenosis, respectively. In case of such criterion for stress test positivity, the improvement in sensitivity provided by addition of MCE (to 94% and 78%, respectively) did not reach statistical significance. Addition of MCE perfusion analysis during stress echocardiographical examination based on evaluation of inducible abnormalities improves the test sensitivity for detection of svCAD. This benefit is less apparent when fixed WMA and perfusion defects are incorporated into the stress test positivity criterion.

Effects of Left Bundle-Branch Block on Cardiac Structure, Function, Perfusion, and Perfusion Reserve

We aimed to investigate the cardiac effects of left bundle-branch block (LBBB) using myocardial contrast echocardiography (MCE) to ascertain the value of MCE for detecting coronary artery disease (CAD) and to uncover the mechanism that affects the accuracy of single-photon emission computed tomography (SPECT) in these patients. Sixty-three symptomatic LBBB patients (group A), 10 left ventricular ejection fraction-matched control subjects without LBBB and no CAD (group B), and 10 normal control subjects (group C) underwent resting echocardiography. Rest and vasodilator MCE and SPECT were undertaken in LBBB patients. Septal (SW) and posterior wall (PW) thickness, thickening, quantitative myocardial blood flow (MBF), and MBF reserve were measured. SW/PW thickness and percentage thickening ratios were lower (P<0.01 and P<0.05, respectively) in group A compared with both groups B and C, but resting SW/PW MBF and MBF reserve ratios were similar in all 3 groups. MBF reserve but not MBF was reduced in groups A and B (2.2+/-0.7 versus 2.2+/-0.2; P=0.98) compared with group C (3.1+/-0.5; P<0.01). SW thickness was an independent predictor (P=0.006) of SPECT perfusion defects in LBBB patients without CAD. MCE (92%) had a sensitivity similar to SPECT (92%); however, the specificity of MCE (95%) was superior (P<0.0001) to SPECT (47%) for the detection of CAD. Despite asymmetrical reduction in SW thickness and function, MBF is preserved and MBF reserve is homogeneously reduced in LBBB patients with left ventricular systolic dysfunction. Because of partial volume effects, the accuracy of SPECT for detecting CAD was significantly compromised compared with MCE in this patient cohort.