Detection of single-vessel coronary artery disease by dipyridamole stress echocardiography: no longer a problem?

Authors: Lipiec, Piotr¹; Wejner-Mik, Paulina¹; Krzemińska-Pakula, Maria¹; Kuśmierek, Jacek²; Plachcińska, Anna²; Szumiński, Remigiusz²; Kasprzak, Jaroslaw D.¹

Source: Clinical Physiology and Functional Imaging, Volume 29, Number 2, March 2009 , pp. 151-157(7)

Publisher: Wiley-Blackwell

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Abstract:

Summary

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 ≥70% stenosis was detected in 30% of patients, whereas 26% of patients had svCAD defined as ≥50% stenosis. Presence of inducible WMA had 35% and 26% sensitivity for detection of svCAD defined as ≥70% and ≥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 ≥70% and ≥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.

Keywords: myocardial perfusion; real-time myocardial contrast echocardiography; single-photon emission computed tomography; single-vessel coronary artery disease; stress echocardiography

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1475-097X.2008.00849.x

Affiliations: 1: 2nd Department of Cardiology, Medical University of Łódź, Łódź, Poland 2: Department of Nuclear Medicine, Medical University of Łódź, Łódź, Poland

Publication date: 2009-03-01

Detection of single-vessel coronary artery disease by dipyridamole stress echocardiography: no longer a problem?

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