Parametric quantification of myocardial ischemia using real-time perfusion adenosine stress echocardiography images. A comparison with SPECT (original) (raw)

Abstract

Background: Real-time perfusion (RTP) adenosine stress echocardiography (ASE) can be used to visually evaluate myocardial ischaemia. The RTP power modulation technique, provides images for off-line parametric perfusion quantification using Qontrast Ò software. From replenishment curves, this generates parametric images of peak signal intensity (A), myocardial blood flow velocity (b) and myocardial blood flow (Axb) at rest and stress. This may be a tool for objective myocardial ischaemia evaluation. We assessed myocardial ischaemia by RTP-ASE Qontrast Ò -generated images, using 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) as reference. Methods: Sixty-seven patients admitted to SPECT underwent RTP-ASE (SONOS 5500) during Sonovue Ò infusion, before and throughout adenosine stress, also used for SPECT. Quantitative off-line analyses of myocardial perfusion by RTP-ASE Qontrast Ò -generated A, b and Axb images, at different time points during rest and stress, were blindly compared to SPECT. Results: We analysed 201 coronary territories [corresponding to the left anterior descendent (LAD), left circumflex (LCx) and right coronary (RCA) arteries] from 67 patients. SPECT showed ischaemia in 18 patients. Receiver operator characteristics and kappa values showed that A, b and Axb image interpretation significantly identified ischaemia in all territories (area under the curve 0AE66-0AE80, P = 0AE001-0AE05). Combined A, b and Axb image interpretation gave the best results and the closest agreement was seen in the LAD territory: 89% accuracy; kappa 0AE63; P<0AE001. Conclusion: Myocardial isachemia can be evaluated in the LAD territory using RTP-ASE Qontrast Ò -generated images, especially by combined A, b and Axb image interpretation. However, the technique needs improvements regarding the LCx and RCA territories.

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