Objective The goal of the present study was to compare real-time three-dimensional echocardiography (RT3DE) to two-dimensional dobutamine stress echocardiography (2DE) for the detection of myocardial ischemia, with angiographic validation of the results.
Methods 56 patients (age 64.5 ± 6.2, 38 males), referred for coronary angiography, were examined by 2DE and RT3DE during the same dobutamine stress protocol.
Results All 56 patients completed the stress protocol uneventfully. The mean acquisition time for the necessary views to evaluate all segments was 26.3 ± 2.5 sec for RT3DE and 58.8 ± 3.7 sec for 2DE (p<0.001). At peak stress, RT3DE reported higher wall-motion score index (1.25±0.24 by 2DE, 1.30±0.27 by RT3DE; p=0.014). We compared the regional wall-motion score for the four apical segments at peak stress which was 1.35±0.55 by 2DE and 1.52±0.69 by RT3DE (p=0.003). The diagnostic parameters of 2DE vs. RT3DE were: sensitivity 73% vs. 78%, specificity 93 vs. 89% and overall accuracy 86% vs. 85%, respectively. In the left anterior descending artery territory, in particular, where RT3DE reported higher regional wall-motion scores, it showed a tendency towards higher sensitivity (85% vs. 78%), although this difference did not achieve statistical significance.
Conclusion In the present study, we report that RT3DE identifies more readily wall-motion abnormalities in the apical region than 2DE, which may explain the tendency towards higher sensitivity in the left anterior descending artery territory. We validate RT3DE results using angiography as reference and our findings indicate diagnostic equivalence to 2DE, with the advantage of significant shorter acquisition times.
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