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Adenosine myocardial contrast echo in intermediate severity coronary stenoses: a prospective two-center study

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Abstract

Background

We sought to evaluate the role of adenosine myocardial contrast echocardiography (MCE) for the determination of functional relevance of coronary stenoses with intermediate angiographic severity and compared the results to single photon imaging (SPECT). We hypothezised that sole assessment of myocardial blood volume changes during adenosine on MCE would indicate functional stensosis relevance when accompanied by increased myocardial oxygen consumption (MVO2).

Methods

Fifty-seven patients with ≥1 coronary stenosis underwent adenosine MCE (ultraharmonic imaging) and exercise SPECT. On MCE, myocardial blood volume was assessed and constant or increased myocardial opacification during adenosine coupled with increased MVO2 was defined as normal and decreased opacification as abnormal.

Results

Rate–pressure product significantly increased during adenosine in all patients due to reflex tachycardia following mild hypotension, indicative of increased MVO2. Concordance between MCE and SPECT for the detection of reversible myocardial perfusion defects was 89% (κ = 0.83). Comparison of regions between rest and during adenosine as opposed to comparison to remote regions of the same stage was important for accurate assessment because concordance betweenn MCE and SPECT was less on separate assessment at rest (73%, κ = 0.40) compared to stress (91%, κ = 0.81, P < 0.05) mainly due to territories scored normal on SPECT and abnormal on MCE.

Conclusions

Assessment of myocardial blood volume changes during adenosine using MCE can be used for the determination of the functional relevance of coronary stenoses of intermediate angiographic severity if MVO2 is increased during adenosine.

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Acknowledgements

Dr. Andrássy was the recipient of a fellowship training grant from the German Cardiac Society. The work was supported by a clinical research grant from Technische Universität München (KKF 87/03). We are indebted to Kevin Wei, M.D. for thoughtful critique of the manuscript.

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Authors and Affiliations

  1. Associate Professor of Medicine,  , Haydnstraße 2, 85293, Reichertshausen, Germany

    Christian Firschke (Associate Professor of Medicine)

  2. Deutsches Herzzentrum, Technische Universität München, München, Germany

    Christian Firschke (Associate Professor of Medicine), Peter Andrássy & Stefan Martinoff

  3. Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, München, Germany

    Raymonde Busch

  4. Abteilung für Kardiologie, Kantonsspital, Universität Basel, Basel, Switzerland

    Andre Z. Linka

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  1. Christian Firschke
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  2. Peter Andrássy
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  3. Andre Z. Linka
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  4. Raymonde Busch
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  5. Stefan Martinoff
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Correspondence to Christian Firschke.

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Firschke, C., Andrássy, P., Linka, A.Z. et al. Adenosine myocardial contrast echo in intermediate severity coronary stenoses: a prospective two-center study. Int J Cardiovasc Imaging 23, 311–321 (2007). https://doi.org/10.1007/s10554-006-9157-9

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  • DOI: https://doi.org/10.1007/s10554-006-9157-9

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