1
|
Iskander J, Kelada P, Rashad L, Massoud D, Afdal P, Abdelmassih AF. Advanced Echocardiography Techniques: The Future Stethoscope of Systemic Diseases. Curr Probl Cardiol 2022; 47:100847. [PMID: 33992429 PMCID: PMC9046647 DOI: 10.1016/j.cpcardiol.2021.100847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease (CVD) has been showing patterns of extensive rise in prevalence in the contemporary era, affecting the quality of life of millions of people and leading the causes of death worldwide. It has been a provocative challenge for modern medicine to diagnose CVD in its crib, owing to its etiological factors being attributed to a large array of systemic diseases, as well as its non-binary hideous nature that gradually leads to functional disability. Novel echocardiography techniques have enabled the cardiac ultrasound to provide a comprehensive analysis of the heart in an objective, feasible, time- and cost-effective manner. Speckle tracking echocardiography, contrast echocardiography, and 3D echocardiography have shown the highest potential for widespread use. The uses of novel modalities have been elaborately demonstrated in this study as a proof of concept that echocardiography has a place in routine general practice with supportive evidence being as recent as its role in the concurrent COVID-19 pandemic. Despite such evidence, many uses remain off-label and unexploited in practice. Generalization of echocardiography at the point of care can become a much-needed turning point in the clinical approach to case management. To actualize such aspirations, we recommend further prospective and interventional studies to examine the effect of implementing advanced techniques at the point of care on the decision-making process and evaluate their effectiveness in prevention of cardiovascular morbidities and mortalities.
Collapse
Affiliation(s)
- John Iskander
- Faculty of Medicine, Cairo University, Cairo, Egypt,Corresponding author: John Iskander, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Kelada
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lara Rashad
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Massoud
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Peter Afdal
- Residency program, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Antoine Fakhry Abdelmassih
- Pediatric Cardiology Unit, Department of Pediatrics, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, Egypt,Consultant of Pediatric Cardiology, Children Cancer Hospital of Egypt (57357 Hospital), Cairo, Egypt
| |
Collapse
|
2
|
Cantoni V, Green R, Acampa W, Zampella E, Assante R, Nappi C, Gaudieri V, Mannarino T, Cuocolo R, Di Vaia E, Petretta M, Cuocolo A. Diagnostic performance of myocardial perfusion imaging with conventional and CZT single-photon emission computed tomography in detecting coronary artery disease: A meta-analysis. J Nucl Cardiol 2021; 28:698-715. [PMID: 31089962 DOI: 10.1007/s12350-019-01747-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND We performed a meta-analysis to compare the diagnostic performance of conventional SPECT (C-SPECT) and cadmium-zinc-telluride (CZT)-SPECT systems in detecting angiographically proven coronary artery disease (CAD). METHODS Studies published between January 2000 and February 2018 were identified by database search. We included studies assessing C-SPECT or CZT-SPECT as a diagnostic test to evaluate patients for the presence of CAD, defined as at least 50% diameter stenosis on invasive coronary angiography. A study was eligible regardless of whether patients were referred for suspected or known CAD. RESULTS We identified 40 eligible articles (25 C-SPECT and 15 CZT-SPECT studies) including 7334 patients (4997 in C-SPECT and 2337 in CZT-SPECT studies). The pooled sensitivity and specificity were 85% and 66% for C-SPECT and 89% and 69% for CZT-SPECT imaging studies. The area under the curve was slightly higher for CZT-SPECT (0.89) compared to C-SPECT (0.83); accordingly, the summary diagnostic OR was 17 for CZT-SPECT and 11 for C-SPECT. The accuracy of the two tests slightly differs between C-SPECT and CZT-SPECT (chi-square 11.28, P < .05). At meta-regression analysis, no significant association between both sensitivity and specificity and demographical and clinical variables considered was found for C-SPECT and CZT-SPECT studies. CONCLUSIONS C-SPECT and CZT-SPECT have good diagnostic performance in detecting angiographic proven CAD, with a slightly higher accuracy for CZT-SPECT. This result supports the use of the novel gamma cameras in clinical routine practices also considering the improvements in acquisition time and radiation exposure reduction.
Collapse
Affiliation(s)
- Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Eugenio Di Vaia
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
3
|
Porter TR, Feinstein SB, Ten Cate FJ, van den Bosch AE. New Applications in Echocardiography for Ultrasound Contrast Agents in the 21st Century. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1071-1081. [PMID: 32115308 DOI: 10.1016/j.ultrasmedbio.2020.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/02/2020] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
Contrast echocardiography microbubbles are ultrasound-enhancing agents that were originally designed to help improve endocardial border definition, known as left ventricle opacification, and to enhance Doppler signals. Over time, contrast microbubbles are used to assess myocardial perfusion because they travel through the capillaries of the cardiac circulation. Current research provides good evidence that myocardial perfusion echocardiography improves comprehensive echocardiographic evaluations of ischemic heart disease. The approval of regulatory authorities and the availability of quantitative operator-independent analysis software will hopefully prompt physicians and sonographers to implement myocardial perfusion echocardiography into the daily workflow of echo laboratories. New diagnostic and therapeutic applications will result in improved patient care, especially in the area of sonothrombolysis, where preliminary data have already shown utilization in ST elevation myocardial infarction, improving left ventricular systolic function and reducing the need for implantable defibrillators at 6-mo follow-up. This review gives an overview of the applications of myocardial perfusion imaging with ultrasound. Each cited study had institutional review board/institutional animal care and use approval.
Collapse
Affiliation(s)
- Thomas R Porter
- Department of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Steve B Feinstein
- Department of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Folkert J Ten Cate
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | |
Collapse
|
4
|
Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, Sawada SG. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:1-41.e8. [DOI: 10.1016/j.echo.2019.07.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
5
|
Scisło P, Kochanowski J, Kołtowski Ł, Opolski G. Utility and safety of three-dimensional contrast low-dose dobutamine echocardiography in the evaluation of myocardial viability early after an acute myocardial infarction. Arch Med Sci 2018; 14:488-492. [PMID: 29765432 PMCID: PMC5949894 DOI: 10.5114/aoms.2016.58650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The aim of the study was to determine the utility and safety of three-dimensional contrast low-dose dobutamine echocardiography (3DCLDDE) in the evaluation of myocardial viability early after ST-elevation myocardial infarction (STEMI). MATERIAL AND METHODS We prospectively evaluated a group of 100 consecutive patients. Myocardial viability was assessed using dobutamine echocardiography in 76 patients with segmental wall motion abnormalities, including 37 patients evaluated using 3DCLDDE and 39 patients evaluated using a standard low-dose dobutamine echocardiography protocol (LDDE), alternately. RESULTS Single ventricular ectopic beats were observed during the test in 1 (2.5%, 1, p = 1) patient in the 3DCLDDE group, while pain (1, p = 1) dyspnea (1, p = 1), single ventricular beats (2, p = 1), and complex ventricular arrhythmia (2, p = 0.49) were noted in 4 (10%) patients in the LDDE group. Five-year survival was 89% in the 3DCLDDE group and 87% in the LDDE group. CONCLUSIONS 3DCLDDE and LDDE are equally safe and useful in patients after STEMI.
Collapse
Affiliation(s)
- Piotr Scisło
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochanowski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Kołtowski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
6
|
Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W, Park MM, Senior R, Villanueva F. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31:241-274. [DOI: 10.1016/j.echo.2017.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
7
|
Schroeder J, Hamada S, Gründlinger N, Rubeau T, Altiok E, Ulbrich K, Keszei A, Marx N, Becker M. Myocardial deformation by strain echocardiography identifies patients with acute coronary syndrome and non-diagnostic ECG presenting in a chest pain unit: a prospective study of diagnostic accuracy. Clin Res Cardiol 2015; 105:248-56. [PMID: 26349786 DOI: 10.1007/s00392-015-0916-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinical assessment often cannot risk stratify patients hospitalized with chest pain and non-diagnostic electrocardiography (ECG) or myocardial enzymes. An inappropriate admission of patients with non-cardiac chest pain is an enormous cost factor. METHODS 2315 patients who presented in the chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS) were screened. All patients with relevant changes in ECG or myocardial enzymes were excluded. 268 consecutive patients (mean 58 ± 7 years, 88 men) were prospectively included and underwent echocardiography for left ventricular ejection fraction (LVEF), wall motion score index (WMSI) and strain parameter and a coronary angiography (CA) within 2 ± 1 days after admission. RESULTS Anatomically obstructive coronary artery disease (CAD) (≥70 % diameter stenosis) was present in 110 patients (41 %). The incremental value of LVEF, WMSI, and strain parameters to relevant clinical variables was determined in nested Cox models. Baseline clinical data associated with relevant CAD were age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) and diabetes (HR 1.46, p = 0.001). The addition of endocardial global circumferential strain (GCS) (HR 1.57, p < 0.001) caused the greatest increment in model power (χ (2) = 43.4, p < 0.001). Optimal cut-off value was calculated as -21.7 % for GCS (sensitivity 87 %, specificity 76 %) to differentiate between these patients. CONCLUSIONS In patients with suspected ACS but without ECG changes or myocardial enzyme abnormalities, myocardial deformation imaging can identify patients at risk. This approach may be applied to improve decision guidance at the CPU for fast discharge of patients with non-cardiac chest pain or prompt cardiological allocation of patients with CAD. CLINICAL TRIAL REGISTRATION NCT 02357641.
Collapse
Affiliation(s)
- Joerg Schroeder
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sandra Hamada
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nina Gründlinger
- Department of Internal Medicine, Hospital St. Brigida, Simmerath, Germany
| | - Tanja Rubeau
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Katrin Ulbrich
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andras Keszei
- Department of Medical Statistics, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Michael Becker
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| |
Collapse
|
8
|
Wierzbowska-Drabik K, Hamala P, Roszczyk N, Lipiec P, Plewka M, Kręcki R, Kasprzak JD. Feasibility and correlation of standard 2D speckle tracking echocardiography and automated function imaging derived parameters of left ventricular function during dobutamine stress test. Int J Cardiovasc Imaging 2014; 30:729-37. [PMID: 24522406 PMCID: PMC3978222 DOI: 10.1007/s10554-014-0386-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Abstract
Speckle tracking echocardiography (STE) is a method of quantitative assessment of myocardial function complementary to ejection fraction and visual evaluation. Standard STE analysis, demands manual tracing of the myocardium whereas automated function imaging (AFI) offers more convenient (based on selection of three points) assessment of longitudinal strain. Nevertheless, feasibility and correlation between both methods were not thoroughly examined, especially during tachycardia at peak stage of dobutamine stress echocardiography (DSE). We performed DSE in 238 patients (pts) with recording of apical views during baseline (0) and peak (1) DSE and analyzed them by STE and AFI. According to angiography, 127/238 pts had significant (≥70%) lesions in coronary arteries. We assessed correlations between STE and AFI derived peak systolic longitudinal strain values for global and regional parameters, feasibility, time of analysis and interobserver agreement. Global systolic longitudinal strain measured during baseline and peak stage of DSE by AFI showed very good correlation with standard STE parameters, with correlation coefficients r = 0.90 and r = 0.86 respectively (p < 0.0001). For regional parameters correlation coefficients ranged from 0.83 to 0.85 for baseline and from 0.70 to 0.79 for peak DSE. Both methods provided good and similar feasibility with only 1% segments excluded from analysis at peak stage of DSE with shorter time and lower coefficient of variance offered by AFI. Global and regional longitudinal strain achieved by faster and less operator-dependent AFI method correlate well with standard more time-consuming STE analysis during baseline and peak stage of DSE.
Collapse
Affiliation(s)
- Karina Wierzbowska-Drabik
- Chair and Department of Cardiology, Medical University of Lodz, Kniaziewicza 1/5, 91-347, Lodz, Poland,
| | | | | | | | | | | | | |
Collapse
|
9
|
Kasprzak JD, Wejner-Mik P, Nouri A, Szymczyk E, Krzemińska-Pakuła M, Lipiec P. Transthoracic measurement of left coronary artery flow reserve improves the diagnostic value of routine dipyridamole-atropine stress echocardiogram. Arch Med Sci 2013; 9:802-7. [PMID: 24273560 PMCID: PMC3832825 DOI: 10.5114/aoms.2013.38673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/12/2011] [Accepted: 10/19/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test. MATERIAL AND METHODS In 64 patients with suspected or known coronary artery disease scheduled for coronary angiography DASE with concomitant CFR measurement in LAD was performed. RESULTS Coronary flow reserve measurement and calculation were feasible in 83% of patients. The positive predictive value of undetectable LAD flow was 81% for severe LAD disease. Measured values of CFR were in the range 1.3-4.1 (mean: 2.2 ±0.7). Significantly lower CFR was found in patients with LAD disease (1.97 ±0.62 vs. 2.55 ±0.57, p = 0.0015). The optimal cutoff for detecting ≥ 50% stenosis was CFR ≤ 2.1 (ROC AUC 0.776), corresponding with 68% sensitivity and 84% specificity. In patients with negative DASE results 67% of patients with LAD disease had abnormal CFR, whereas in patients with a positive DASE result 92% of patients with normal LAD had normal CFR. The DASE diagnostic accuracy for the detection of coronary artery disease (CAD) increased from 75% to 85% when CFR measurement was added to wall motion abnormality (WMA) analysis. No test with both abnormalities was false positive for the detection of coronary disease. CONCLUSIONS Incorporation of CFR measurement into WMA-based stress echocardiography is feasible even in an accelerated DASE protocol and can be translated into an approximate gain of 10% in overall test accuracy.
Collapse
|
10
|
Abstract
Background—
The addition of myocardial perfusion (MP) imaging during dipyridamole real-time contrast echocardiography improves the sensitivity to detect coronary artery disease, but its prognostic value to predict hard cardiac events in large numbers of patients with known or suspected coronary artery disease remains unknown.
Methods and Results—
We studied 1252 patients with the use of dipyridamole real-time contrast echocardiography and followed them for a median of 25 months. The prognostic value of MP imaging regarding death and nonfatal myocardial infarction was determined and related to wall motion (WM), clinical risk factors, and rest ejection fraction by the use of Cox proportional-hazards models, C index, and risk reclassification analysis. A total of 59 hard events (4.7%) occurred during the follow-up (24 deaths, 35 myocardial infarctions). The 2-year event-free survival was 97.9% in patients with normal MP and WM, 91.9% with isolated reversible MP defects but normal WM, and 67.4% with both reversible MP and WM abnormalities (
P
<0.001). By multivariate analysis the independent predictors of events were age (hazard ratio 1.05, 95% confidence interval [CI], 1.02–1.08), sex (hazard ratio, 2.36; 95% CI, 1.32–4.23), reversible MP defects (hazard ratio, 3.88; 95% CI, 1.83–8.21), and reversible WM abnormalities with reversible MP defects (hazard ratio, 4.51; 95% CI, 2.25–9.07). Reversible MP defects added incremental predictive value and reclassification benefit over WM response and clinical factors (
P
=0.001).
Conclusions—
MP imaging using real-time perfusion echocardiography during dipyridamole real-time contrast echocardiography provides independent, incremental prognostic information regarding hard cardiac events in patients with known or suspected coronary artery disease. Patients with normal MP responses have better outcome than patients with normal WM; patients with both reversible WM and MP abnormalities have the worst outcome.
Collapse
|
11
|
de Jong MC, Genders TSS, van Geuns RJ, Moelker A, Hunink MGM. Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis. Eur Radiol 2012; 22:1881-95. [PMID: 22527375 PMCID: PMC3411304 DOI: 10.1007/s00330-012-2434-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/23/2012] [Accepted: 02/04/2012] [Indexed: 12/11/2022]
Abstract
Objectives To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard. Methods We searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Results All pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.26–4.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.28–3.25; P = 0.006) and that of ECHO (2.83; 95 % CI 2.29–3.37; P = 0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P = 0.52). Conclusion Our results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance. Key Points • MRI can assess myocardial perfusion. • MR perfusion diagnoses coronary artery disease better than echocardiography or SPECT. • Echocardiography and SPECT have similar diagnostic performance. • MRI can save coronary artery disease patients from more invasive tests. • MRI and SPECT show evidence of publication bias, implying possible overestimation. Electronic supplementary material The online version of this article (doi:10.1007/s00330-012-2434-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marcus C de Jong
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|
12
|
Squeri A, Gaibazzi N, Reverberi C, Caracciolo MM, Ardissino D, Gherli T. Ejection fraction change and coronary artery disease severity: a vasodilator contrast stress-echocardiography study. J Am Soc Echocardiogr 2012; 25:454-9. [PMID: 22243999 DOI: 10.1016/j.echo.2011.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND An important goal of noninvasive stress testing is the identification of patients with left main coronary artery or three-vessel disease, because coronary artery disease extension and severity are major prognostic factors in ischemic heart disease. Wall motion abnormalities during vasodilator stress echocardiography become apparent in more than one coronary territory only in a small number of patients with multivessel disease. The aim of this study was to assess the value of change in left ventricular ejection fraction change (ΔLVEF) to identify patients with multivessel obstructive coronary artery disease during dipyridamole stress echocardiography. METHODS All dipyridamole stress echocardiographic studies performed at the authors' institution from October 2007 through March 2010 were retrospectively reviewed, and 150 patients who underwent coronary angiography within the next 60 days were selected. Left ventricular end-diastolic volume and end-systolic volume were measured at baseline and at the end of high-dose dipyridamole; ΔLVEF was calculated as stress ejection fraction minus rest ejection fraction. Patients were divided into four groups (controls and patients with single-vessel, two-vessel, and three-vessel disease) on the basis of coronary angiographic results. RESULTS The mean LVEF increased significantly from rest to peak stress in all groups except the three-vessel disease group. Mean ΔLVEF was negative in patients with three-vessel or left main coronary artery disease (-2.8 ± 5.1%) and significantly lower compared with all other angiographic groups (10.2 ± 5.1% and 6.2 ± 4.1%, respectively, for single-vessel and two-vessel disease). The negative value of ΔLVEF for three-vessel disease was due mainly to increased end-systolic volume at peak stress. Receiver operating characteristic curves demonstrated excellent accuracy of ΔLVEF compared with change in wall motion score index in identifying patients with multivessel disease, with areas under the curves of 0.96 and 0.62, respectively. CONCLUSIONS ΔLVEF is significantly lower in patients with severe coronary artery disease compared with those with single-vessel or two-vessel disease; reduced ΔLVEF identifies high-risk patients, who are likely to benefit from a more aggressive therapeutic strategy.
Collapse
Affiliation(s)
- Angelo Squeri
- U.O. Cardiologia, Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliero, Universitaria di Parma, Via Gramsci 14, Parma, Italy.
| | | | | | | | | | | |
Collapse
|
13
|
Gaibazzi N, Rigo F, Reverberi C. Detection of Coronary Artery Disease by Combined Assessment of Wall Motion, Myocardial Perfusion and Coronary Flow Reserve: A Multiparametric Contrast Stress-Echocardiography Study. J Am Soc Echocardiogr 2010; 23:1242-50. [DOI: 10.1016/j.echo.2010.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Indexed: 11/16/2022]
|
14
|
Gaibazzi N, Rigo F, Squeri A, Ugo F, Reverberi C. Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography. Cardiovasc Ultrasound 2010; 8:16. [PMID: 20459632 PMCID: PMC2877655 DOI: 10.1186/1476-7120-8-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/06/2010] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI) for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE). Wall motion (WM) assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD), particularly in patients with isolated intermediate (50%-70%) coronary stenosis. Methods We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography. Results and discussion When CAD was defined as the presence of a ≥50% stenosis, the addition of MPI increased sensitivity (+30%) and decreased specificity (-14%), with a final increase in total diagnostic accuracy (+16%, p < 0.001). The addition of MPI data substantially increased the sensitivity to detect patients with isolated intermediate stenosis from 37% to 98% (p < 0.001); the incremental sensitivity was much lower in patients with severe stenosis, from 85% to 96% (p < 0.05), at the expense of a higher decrease in specificity and a final decrease in total diagnostic accuracy (-18%, p < 0.001). Conclusions The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (≥50% or > 70% stenosis), but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis). The total diagnostic accuracy increased only when defining CAD as ≥50% stenosis, since in patients with severe stenosis (> 70%) the decrease in specificity is not counterbalanced by the minor sensitivity increase.
Collapse
Affiliation(s)
- Nicola Gaibazzi
- Cardiology Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | | | | |
Collapse
|
15
|
Porter TR, Xie F. Myocardial perfusion imaging with contrast ultrasound. JACC Cardiovasc Imaging 2010; 3:176-87. [PMID: 20159645 DOI: 10.1016/j.jcmg.2009.09.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 08/06/2009] [Accepted: 09/17/2009] [Indexed: 10/19/2022]
Abstract
This report reviews the development and clinical application of myocardial perfusion imaging with myocardial contrast echocardiography (MCE). This includes the development of microbubble formulations that permit the detection of left ventricular contrast from venous injection and the imaging techniques that have been invented to detect the transit of these microbubbles through the microcirculation. The methods used to quantify myocardial perfusion during a continuous infusion of microbubbles are described. A review of the clinical studies that have examined the clinical utility of myocardial perfusion imaging with MCE during rest and stress echocardiography is then presented. The limitations of MCE are also discussed.
Collapse
Affiliation(s)
- Thomas R Porter
- University of Nebraska Medical Center, Cardiology,981165 Nebraska Medical Center, Omaha, Nebraska 68198-1165, USA.
| | | |
Collapse
|
16
|
Gudmundsson P, Shahgaldi K, Winter R, Dencker M, Kitlinski M, Thorsson O, Ljunggren L, Willenheimer R. Parametric quantification of myocardial ischaemia using real-time perfusion adenosine stress echocardiography images, with SPECT as reference method. Clin Physiol Funct Imaging 2010; 30:30-42. [DOI: 10.1111/j.1475-097x.2009.00901.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Affiliation(s)
- Michael Salerno
- From the University of Virginia Health System, Charlottesville, Va
| | - George A. Beller
- From the University of Virginia Health System, Charlottesville, Va
| |
Collapse
|
18
|
Dawson D, Kaul S, Peters D, Rinkevich D, Schnell G, Belcik JT, Wei K. Prognostic value of dipyridamole stress myocardial contrast echocardiography: comparison with single photon emission computed tomography. J Am Soc Echocardiogr 2009; 22:954-60. [PMID: 19553084 DOI: 10.1016/j.echo.2009.04.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dipyridamole stress myocardial contrast echocardiography (MCE) can be used to detect coronary artery disease (CAD). Because it measures myocardial blood flow velocity in addition to measuring myocardial blood volume, it was hypothesized that it should have greater prognostic utility than single photon-emission computed tomography (SPECT), which measures only myocardial blood volume. Because blood flow mismatch precedes wall thickening (WT) abnormalities during demand ischemia, it was also postulated that perfusion on MCE would be superior to WT abnormalities on echocardiography for this purpose. METHODS The incidence of nonfatal myocardial infarction and cardiac death was determined in 261 patients with known or suspected CAD over a mean follow-up period of 14 months who underwent simultaneous dipyridamole stress MCE and 99mTc-sestamibi SPECT. Comparisons of survival curves were conducted with stratified (and unstratified) log-rank tests. RESULTS Abnormal results on MCE were found to be the best predictor of an adverse outcome (odds ratio, 23; 95% confidence interval, 6-201; P<.0001) and provided incremental prognostic value over clinical variables (age>60 years, the presence of >or=3 cardiac risk factors, known peripheral vascular disease, prior myocardial infarction, and left ventricular systolic function), inducible WT abnormalities, and SPECT. Prognoses were worst in patients who had both abnormal results on MCE and inducible WT abnormalities and best in those who had neither. Patients with abnormal results on MCE but no inducible WT abnormalities had intermediate outcomes. CONCLUSION In patients with known or suspected CAD undergoing dipyridamole stress, MCE provides powerful prognostic information that is superior to clinical variables, electrocardiography, left ventricular systolic function, WT analysis, and SPECT. MCE may therefore serve as a method of choice for myocardial perfusion assessment in patients with known or suspected CAD. Larger studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Dana Dawson
- Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
| | | | | | | | | | | | | |
Collapse
|
19
|
Gudmundsson P, Shahgaldi K, Winter R, Dencker M, Kitlinski M, Thorsson O, Ljunggren L, Willenheimer RB. Head to head comparisons of two modalities of perfusion adenosine stress echocardiography with simultaneous SPECT. Cardiovasc Ultrasound 2009; 7:19. [PMID: 19379491 PMCID: PMC2678085 DOI: 10.1186/1476-7120-7-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/20/2009] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Real-time perfusion (RTP) contrast echocardiography can be used during adenosine stress echocardiography (ASE) to evaluate myocardial ischemia. We compared two different types of RTP power modulation techniques, angiomode (AM) and high-resolution grayscale (HR), with 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia. METHODS Patients with known or suspected coronary artery disease (CAD), admitted to SPECT, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using AM and HR during Sonovue(R) infusion, before and throughout the adenosine stress, also used for SPECT. Analysis of myocardial perfusion and wall motion by RTP-ASE were done for AM and HR at different time points, blinded to one another and to SPECT. Each segment was attributed to one of the three main coronary vessel areas of interest. RESULTS In 50 patients, 150 coronary areas were analyzed by SPECT and RTP-ASE AM and HR. SPECT showed evidence of ischemia in 13 out of 50 patients. There was no significant difference between AM and HR in detecting ischemia (p = 0.08). The agreement for AM and HR, compared to SPECT, was 93% and 96%, with Kappa values of 0.67 and 0.75, respectively (p < 0.001). CONCLUSION There was no significant difference between AM and HR in correctly detecting myocardial ischemia as judged by SPECT. This suggests that different types of RTP modalities give comparable data during RTP-ASE in patients with known or suspected CAD.
Collapse
Affiliation(s)
- Petri Gudmundsson
- Department of Clinical Physiology, Lund University, Malmö University Hospital, Malmö, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Contrast Stress Echocardiography for the Diagnosis of Coronary Artery Disease in Patients With Chest Pain but Without Acute Coronary Syndrome: Incremental Value of Myocardial Perfusion. J Am Soc Echocardiogr 2009; 22:404-10. [DOI: 10.1016/j.echo.2009.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Indexed: 11/19/2022]
|
21
|
[Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance, and multidetector computed tomography]. Rev Esp Cardiol 2009; 62 Suppl 1:129-50. [PMID: 19174056 DOI: 10.1016/s0300-8932(09)70047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article contains a review of the most important publications on cardiac imaging that have appeared during 2008. During the year, we assisted with the clinical implementation of three-dimensional real-time transesophageal echocardiography, with the use of echocardiography for selecting patients for and monitoring those who underwent percutaneous aortic valve replacement (the majority of centers performing the technique were still in the learning phase), and with the emergence in the clinic of techniques for studying myocardial deformation. Also reviewed are the most significant developments in the application of echocardiography to coronary heart disease and cardiac resynchronization therapy and in 2 other techniques whose use is constantly increasing: cardiac magnetic resonance and multidetector cardiac computed tomography. The review ends with a description of the current state of the art in contrast echocardiography, with particular emphasis on safety in the context of recommendations made by the US Food and Drug Administration at the end of 2007.
Collapse
|
22
|
Lipiec P, Wejner-Mik P, Krzemińska-Pakula M, Kuśmierek J, Plachcińska A, Szumiński R, Kasprzak JD. Detection of single-vessel coronary artery disease by dipyridamole stress echocardiography: no longer a problem? Clin Physiol Funct Imaging 2009; 29:151-7. [PMID: 19222128 DOI: 10.1111/j.1475-097x.2008.00849.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Piotr Lipiec
- 2nd Department of Cardiology, Bieganski Hospital, Medical University of Łódź, Łódź, Poland.
| | | | | | | | | | | | | |
Collapse
|