MCE for detection of myocardial ischaemia

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Contrast stress echocardiography predicts hard cardiac events in patients with suspected acute coronary syndrome but non-diagnostic electrocardiogram and negative 12-hr troponin.

Gaibazzi N, Squeri A, Reverberi C, Molinaro S, Lorenzoni V, Sartorio D, Senior R.
Comment:
This is the first study to demonstrate the incremental benefit of myocardial perfusion assessment in this acute patient population. 545 patients referred from the Emergency Department underwent dipyridamole-atropine stress echocardiography and were followed-up for 12months thereafter. Abnormal MCE was the single best predictor of adverse cardiac events, both hard events and a composite end-point including hospitalisation for recurrent angina. The inclusion of MCE results significantly improved the multivariate model, even with inclusion of wall motion data.
Reference: J Am Soc Echo (2011); 24(12); 1333-41

Myocardial contrast echocardiography for the detection of coronary artery stenosis: a prospective multicenter study in comparison with single-photon emission computed tomography

Jeetley P, Hickman M, Kamp O, Lang RM, Thomas JD, Vannan MA, et al.
Comment:
123 patients clinically scheduled to undergo coronary angiography underwent triggered intermediate mechanical index (0.5) MCE and SPECT at rest and after vasodilator stress. 78% patients had ≥1 coronary stenosis >50%. MCE and SPECT had similar sensitivity (84% vs 82%) and specificity (56% vs 52%) for detection of CAD in this high-risk cohort.
Reference: J Am Coll Cardiol 2006;47(1):141-5

Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography

Tsutsui JM, Elhendy A, Anderson JR, Xie F, McGrain AC & Porter TR.
Comment:
This key paper involved a retrospective analysis of 788 patients who had undergone MCE during stress echocardiography with dobutamine. For the first time, incremental prognostic value over clinical variables and, crucially, wall motion was proven – patients with normal perfusion had better outcomes (median follow-up period 20months) than those with normal wall motion.
Reference: Circulation. 2005; 112(10); 1444-50

Usefulness of myocardial contrast echocardiography derived coronary flow reserve to accurately determine severity of left anterior descending coronary artery stenosis

Hickman M, Jeetley P, Senior R.
Comment:
This study in 35 patients proved that MCE can detect not just the presence but also the severity of CAD in patients with LAD coronary stenosis. Quantitative MCE was performed up to 4 weeks prior to coronary angiography. Patients were divided into four groups based on severity of LAD stenosis (<50%, 50-75%, 75-99% and 100% occlusion). MCE-derived coronary flow reserve was significantly different between each of the four groups and accurately predicted severity of disease.
Reference: Am J Cardiol 2004;93(9):1159-62

Assessment of the physiologic significance of coronary disease with dipyridamole real-time myocardial contrast echocardiography. Comparison with technetium-99m sestamibi single-photon emission computed tomography and quantitative coronary angiography

Peltier M, Vancraeynest D, Pasquet A, Ay T, Roelants V, D'hondt AM, Melin JA, Vanoverschelde JL.
Comment:
Thirty-five patients referred for coronary angiography underwent RT-MCE and technetium-99m SPECT at baseline and after 0.84 mg/kg dipyridamole. Qualitative & quantitative analysis were performed and real-time MCE was shown to be both highly sensitive and specific for detection of CAD. The authors concluded that RT-MCE, with dipyridamole, can define the presence and severity of coronary disease in a manner that compares favourably with quantitative SPECT.
Reference: J Am Coll Cardiol. 2004; 43(2); 257-64

Non-invasive quantification of coronary blood flow reserve in humans using myocardial contrast echocardiography

Wei K, Ragosta M, Thorpe J, Coggins M, Moos S & Kaul S.
Comment:
11 patients with normal epicardial coronary arteries (group I) and 19 with single-vessel coronary stenosis (group II) underwent angiography, MCE and CBF velocity measurements at rest and during intravenous adenosine infusion. In group I patients, MCE-derived myocardial blood flow (MBF) velocity reserve was similar to CBF velocity reserve using a Doppler flow wire. In group II patients, significant differences were found in MBF velocity reserve in patients with mild (<50%), moderate (50% to 75%), or severe (>75%) stenoses. A linear relation was found between flow velocity reserve determined using the 2 methods and the authors concluded that coronary flow reserve can be measured in humans using MCE.
Reference: Circulation 2001; 103(21); 2560-5

Detection of coronary artery disease with myocardial contrast echocardiography: comparison with 99mTc-sestamibi single-photon emission computed tomography

Kaul S, Senior R, Dittrich H, Raval U, Khattar R & Lahiri A.
Comment:
This was the first study to compare MCE with nuclear imaging (SPECT) for detection of coronary artery disease. 30 patients with known or suspected CAD underwent MCE and 99mTc-sestamibi SPECT at baseline and after dipyridamole. Concordance between segmental scores was 92% (k=0.99) for both methods, between normal perfusion and reversible or irreversible segmental defects was 90% (k=0.80) and agreement between the two methods for each of the three vascular territories in each patient was 90% (k=0.77) and thus it was shown that MCE can provide similar diagnostic accuracy to SPECT for detection of CAD.
Reference: Circulation. 1997; 96(3); 785-92

MCE for detection of myocardial ischaemia

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