Adenosine myocardial contrast echo in intermediate severity coronary stenoses: a prospective two-center study
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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).
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.
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.
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.
KeywordsCoronary disease Contrast media Echocardiography
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.
- 1.Hachamovitch R, Berman DS, Shaw LJ et al (1998) Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction [published erratum appears in Circulation (1998) 98(2):190]. Circulation 97:535–543Google Scholar
- 2.Vanzetto G, Ormezzano O, Fagret D, Comet M, Denis B, Machecourt J (1999) Long-term additive prognostic value of thallium-201 myocardial perfusion imaging over clinical and exercise stress test in low to intermediate risk patients: study in 1137 patients with 6-year follow-up. Circulation 100:1521–1527PubMedGoogle Scholar
- 7.Ryan TJ, Bauman WB, Kennedy JW et al (1993) Guidelines for percutaneous transluminal coronary angioplasty. A report of the American Heart Association/American College of Cardiology Task Force on assessment of diagnostic and therapeutic cardiovascular procedures (Committee on Percutaneous Transluminal Coronary Angioplasty). Circulation 88:2987–3007Google Scholar
- 17.Senior R, Lepper W, Pasquet A, Chung G, Hoffmann R, Vanoverschelde JL, Cerqueira M, Kaul S (2004) Myocardial perfusion assessment in patients with medium probability of coronary artery disease and no prior myocardial infarction: comparison of myocardial contrast echocardiography with 99m Tc single-photon emission computed tomography. Am Heart J 147(6):1100–5PubMedCrossRefGoogle Scholar
- 21.Korosoglou G, DaSilva K, Labadze N, Dubart A, Hansen A, Rosenberg M, Zehelein J, Kuecherer H (2004) Real-time myocardial contrast echocardiography for pharmacologic stress testing: is quantitative estimation of myocardial blood flow reserve necessary? J Am Soc Echocardiogr 17:1–9PubMedCrossRefGoogle Scholar
- 23.Crystal GJ, Downey HF, Bashour F (1981) Small vessel and total coronary blood volume during intracoronary adenosine. Am J Physiol 41:H194–H201Google Scholar