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Myocardial contrast echocardiography in human beings: correlation of resting perfusion defects to sestamibi single
M F Meza1, S Mobarek, R Sonnemaker
1Ochsner Medical Institutions, Department of Internal Medicine, New Orleans, LA 70121, USA.
Insights
Myocardial contrast echocardiography (MCE) and sestamibi single photon emission computed tomography (SPECT) are comparable for detecting coronary artery disease. Both imaging techniques effectively identify severely underperfused myocardium in patients.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Myocardial perfusion abnormalities often indicate coronary artery disease.
- Myocardial contrast echocardiography (MCE) shows promise in animal models for identifying at-risk areas post-coronary occlusion.
Purpose of the Study:
- To compare the accuracy of MCE and sestamibi single photon emission computed tomography (SPECT) in detecting myocardial perfusion defects in humans.
- To evaluate the agreement in presence, size, and location of perfusion defects between MCE and SPECT.
Main Methods:
- 41 patients underwent both MCE and sestamibi SPECT.
- Perfusion defects were analyzed for presence, size, and location.
- Data were compared using linear regression analysis.
Main Results:
- MCE detected defects in 29% of patients, SPECT in 46%, and both in 27%.
- Overall agreement between MCE and SPECT was 78% for presence/absence of defects.
- Concordance for defect location was 86%, and a significant correlation (r=0.62, p<0.001) was found for defect size.
Conclusions:
- MCE and sestamibi SPECT demonstrate comparable performance in identifying severely underperfused myocardium in humans.
- These findings support the use of both MCE and SPECT as reliable diagnostic tools for coronary artery disease assessment.
Abstract:
The presence of myocardial perfusion abnormalities is generally accepted to suggest underlying coronary artery disease. In previous animal studies, myocardial contrast echocardiography (MCE) has been shown to be useful in delineating areas at risk after coronary occlusions. We sought to compare the presence or absence, size, and location of perfusion defects detected in human beings by MCE and sestamibi single photon emission computed tomography (SPECT). Regional wall motion was qualitatively assessed in the parasternal and apical views of a resting two-dimensional echocardiogram. Coronary angiography was performed in all patients and myocardial contrast echocardiography performed with 2 ml of intracoronary sonicated meglumine (Nycomed). A cine loop of the digitized contrast echocardiograms was used to analyze perfusion defects. Gated SPECT resting images in standard views were obtained after technetium 99m sestamibi (20 mCi) was administered. Visually perceived perfusion defects were established at 30% of maximal counts at end diastole. Perfusion defects by both techniques were planimetered, assigned to one of three perfusion artery territories, and expressed as a percentage of the perfusion territory studied. Comparison was made by linear regression analysis. Forty-one patients were studied. Perfusion defects were observed in 12 (29%) patients by MCE, 19 (46%) patients by SPECT, and 11 (27%) patients by both techniques. No perfusion defects were detected by MCE in 29 (70%) patients, by SPECT in 22 (53%) patients, or by either technique in 21 (51%) patients. The two techniques agreed in 78% of the patients. In 67 matching orthogonal views suitable for comparison between the two techniques, an 82% concordance for the presence or absence of defects was observed. The location of the defects matched in 86% of the cases. A significant correlation (p < 0.001; r = 0.62) between these techniques was observed in assessing the size of perfusion defects. In conclusion, our results suggest that MCE and sestamibi SPECT are comparable techniques for detecting severely underperfused myocardium in human beings.