TITLE

Absolute myocardial blood flow determination using real-time myocardial contrast echocardiography during adenosine stress: comparison with single-photon emission computed tomography

AUTHOR(S)
Abdelmoneim, S. S.; Dhoble, A.; Bernier, M.; Moir, S.; Hagen, M. E.; Ness, S. A. C.; Abdel-Kader, S. S.; Pellikka, P. A.; Mulvagh, S. L.
PUB. DATE
October 2009
SOURCE
Heart;Oct2009, Vol. 92 Issue 20, p1662
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To assess the feasibility and diagnostic accuracy of real-time myocardial contrast echocardiography (MCE)-derived absolute myocardial blood flow for detection of myocardial perfusion abnormalities compared with simultaneous technetium 99 m sestamibi single-photon emission computed tomography (SPECT). Design: Prospective study. Setting: Tertiary-care medical institution. Patients: 79 patients with known or suspected coronary artery disease. Interventions: Simultaneous SPECT and real-time MCE during adenosine stress. Main outcome measures: Absolute myocardial blood flow (MBF, ml/min/g), microbubble velocity (β, min-1), and reserve values. Endpoints included sensitivity, specificity, positive likelihood ratio (LR+) or negative likelihood ratio (LR-) and area under the curve (AUC) of the receiver operating characteristic curve. Results: Reserve measurements were feasible in 975 of 1343 segments (73%); of these, 130 segments (13%) were abnormal by SPECT. MCE perfusion parameters clearly distinguished abnormal from normal segments for β reserve (1.13 (0.99) vs 2.22 (1.36), p<0.001) and MBF reserve (1.80 (2.29) vs 3.69 (2.79), p<0.001). The β reserve cut-off of 1.60 provided the following: AUC, 0.787; sensitivity, 82%; specificity, 66%; LR+, 2.40; and LR-, 0.28. The MBF reserve cut-off of 1.90 provided the following: AUC, 0.779; sensitivity, 73%; specificity, 72%; LR+, 2.69; and LR-, 0.37. MBF reserve had an AUC of 0.773 for the left anterior descending coronary artery, 0.885 for the left circumflex coronary artery and 0.739 for the right coronary artery. Conclusions: Real-time MCE-derived absolute MBF, β, and reserve values are feasible and accurate for detecting myocardial perfusion abnormalities as defined by SPECT.
ACCESSION #
44532552

 

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