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Updated: Jun 13, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis
Nicola Gaibazzi1, Fausto Rigo, Angelo Squeri
1Cardiology Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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 >or=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 (>or=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 >or=50% stenosis, since in patients with severe stenosis (> 70%) the decrease in specificity is not counterbalanced by the minor sensitivity increase.
Insights
Contrast myocardial perfusion imaging (MPI) significantly improves the detection of intermediate coronary artery stenosis during dipyridamole-atropine echocardiography (DASE). This enhancement is crucial for diagnosing coronary artery disease (CAD) in patients with moderate blockages.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Wall motion assessment in stress echocardiography has limited sensitivity for detecting coronary artery disease (CAD), especially intermediate coronary artery stenosis (50%-70%).
- Contrast myocardial perfusion imaging (MPI) offers a potential improvement for detecting significant coronary artery stenosis.
Purpose of the Study:
- To evaluate the added diagnostic value of contrast myocardial perfusion imaging (MPI) in detecting intermediate versus severe coronary artery stenosis.
- To compare the effectiveness of dipyridamole-atropine echocardiography (DASE) with and without MPI for CAD diagnosis.
Main Methods:
- 150 patients with suspected chest pain underwent DASE with MPI.
- Coronary angiography was used as the gold standard for defining coronary artery stenosis.
Main Results:
- Adding MPI to DASE increased sensitivity by 30% and diagnostic accuracy by 16% (p < 0.001) for detecting CAD defined as >=50% stenosis.
- MPI substantially improved sensitivity for intermediate stenosis (50%-70%) from 37% to 98% (p < 0.001).
- For severe stenosis (>70%), MPI offered a smaller sensitivity increase (85% to 96%) with a greater specificity decrease.
Conclusions:
- Contrast MPI significantly enhances the diagnostic sensitivity of DASE for obstructive coronary artery disease, particularly for intermediate stenosis.
- The overall diagnostic accuracy improves when CAD is defined as >=50% stenosis, but not for severe stenosis alone due to specificity reduction.
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