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document
Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice : comparison with wall motion and technetium-99m sestamibi single-photon emission computed tomography . The Nycomed NC100100 Investigators . OBJECTIVES We sought to assess the feasibility and accuracy of myocardial contrast echocardiography ( MCE ) using standard imaging approaches for the detection of perfusion defects in patients who had a myocardial infarction ( MI ) . BACKGROUND Myocardial contrast echocardiography may be more versatile than perfusion scintigraphy for identifying the presence and extent of perfusion defects after MI . However , its reliability in routine practice is unclear . METHODS Fundamental or harmonic MCE was performed with continuous or triggered imaging in 203 patients with a previous MI using bolus doses of a perfluorocarbon-filled contrast agent ( NC100100 ) . All patients underwent single-photon emission computed tomography ( SPECT ) after the injection of technetium-99m ( Tc-99m ) sestamibi at rest . Quantitative and semiquantitative SPECT , wall motion and digitized echocardiographic data were interpreted independently . The accuracy of MCE was assessed for detection of segments and patients with moderate and severe sestamibi-SPECT defects , as well as for detection of patients with extensive perfusion defects ( > 12 % of left ventricle ) . RESULTS In segments with diagnostic MCE , the segmental sensitivity ranged from 14 % to 65 % , and the specificity varied from 78 % to 95 % , depending on the dose of contrast agent . Using both segment- and patient-based analysis , the greatest accuracy and proportion of interpretable images were obtained using harmonic imaging in the triggered mode . For the detection of extensive defects , the sensitivity varied from 13 % to 48 % , with specificity from 63 % to 100 % . Harmonic imaging remained the most accurate approach . Time since MI and SPECT defect location and intensity were all determinants of the MCE response . The extent of defects on MCE was less than the extent of either abnormal wall motion or SPECT abnormalities . The combination of wall motion and MCE assessment gave the best balance of sensitivity ( 46 % to 55 % ) and specificity ( 82 % to 83 % ) . CONCLUSIONS Although MCE is specific , it has limited sensitivity for detection of moderate or severe perfusion defects , and it underestimates the extent of SPECT defects . The best results are obtained by integration with wall motion . More sophisticated methods of acquisition and interpretation are needed to enhance the feasibility of this technique in routine practice .
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Intervention_Physical
contrast echocardiography
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Intervention_Physical
wall motion and technetium-99m sestamibi single-photon emission computed tomography .
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Intervention_Physical
myocardial contrast echocardiography ( MCE )
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Intervention_Physical
Myocardial contrast echocardiography
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Intervention_Physical
perfusion scintigraphy
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Intervention_Pharmacological
perfluorocarbon-filled contrast agent ( NC100100 )
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Intervention_Physical
single-photon emission computed tomography ( SPECT )
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Intervention_Physical
SPECT
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Intervention_Physical
MCE
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Outcome_Physical
segmental sensitivity
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Outcome_Other
specificity
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Outcome_Physical
sensitivity
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Outcome_Other
Time since MI
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Outcome_Other
SPECT defect location and intensity
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Outcome_Adverse-effects
extent of defects on MCE
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Outcome_Adverse-effects
moderate or severe perfusion defects
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Outcome_Adverse-effects
SPECT defects