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Contrast-enhanced three-dimensional dobutamine stress echocardiography: between Scylla and Charybdis?

Boudewijn J Krenning1, Attila Nemes, Osama I I Soliman

  • 1Department of Cardiology, Erasmus MC, Thoraxcenter, Room Ba 316, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. b.krenning@erasmusmc.nl

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology
|May 21, 2008
PubMed

Insights

Contrast-enhanced stress RT3DE shows moderate accuracy for detecting coronary artery disease (CAD). While improving image quality and interobserver agreement, technical limitations affect its diagnostic sensitivity for CAD.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Real-time three-dimensional echocardiography (RT3DE) offers rapid volumetric assessment of the left ventricle (LV).
  • Coronary artery disease (CAD) diagnosis relies on accurate detection of myocardial ischemia.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of contrast-enhanced stress RT3DE for detecting CAD.
  • To compare contrast-enhanced stress RT3DE against coronary arteriography, the gold standard.

Main Methods:

  • Forty-five patients referred for coronary angiography underwent contrast-enhanced RT3DE.
  • Off-line wall motion analysis was performed using dedicated software.
  • Image quality and interobserver agreement were assessed, comparing contrast-enhanced RT3DE with conventional RT3DE.

Main Results:

  • Sensitivity for detecting significant CAD was 61% (17/28 patients), with a specificity of 88% (2/17 patients).
  • Sensitivity varied by CAD severity: 53% for single-vessel, 67% for two-vessel, and 71% for three-vessel disease.
  • Contrast enhancement significantly improved image quality (P < 0.001) and interobserver agreement for diagnosing myocardial ischemia (kappa = 0.69 vs 0.44).

Conclusions:

  • Contrast-enhanced stress RT3DE demonstrates moderate diagnostic sensitivity for CAD.
  • Technical limitations, including temporal and spatial resolution, currently impact its diagnostic performance.
  • Despite limitations, contrast enhancement offers practical benefits in image quality and diagnostic confidence.
Abstract

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