Objective: To assess the feasibility and diagnostic accuracy of real-time myocardial contrast echocardiography (MCE)-derived absolute myocardial blood flow for detection of myocardial perfusion abnormalities compared with simultaneous technetium 99m sestamibi single-photon emission computed tomography (SPECT).
Design: Prospective study.
Setting: Tertiary-care medical institution.
Patients: Seventy-nine patients with known or suspected coronary artery disease.
Interventions: Simultaneous SPECT and real-time MCE during adenosine stress.
Main outcome measures: Absolute myocardial blood flow (MBF, mL/min/g), microbubble velocity (β, min−1), and reserve values. End points included sensitivity, specificity, positive likelihood ratio (LR+) or negative likelihood ratio (LR−), and area under the curve (AUC) of the receiver operating characteristic curve.
Results: Reserve measurements were feasible in 975 of 1,343 segments (73%); of these, 130 segments (13%) were abnormal by SPECT. MCE perfusion parameters clearly distinguished abnormal from normal segments for β reserve (1.13±0.99 vs 2.22±1.36, P<.001) and MBF reserve (1.80±2.29 vs 3.69±2.79, P<.001). The β reserve cutoff of 1.60 provided the following: AUC, 0.787; sensitivity, 82%; specificity, 66%; LR+, 2.40; and LR−, 0.28. The MBF reserve cutoff of 1.90 provided the following: AUC, 0.779; sensitivity, 73%; specificity, 72%; LR+, 2.69; and LR−, 0.37. MBF reserve had an AUC of 0.773 for the left anterior descending coronary artery, 0.885 for the left circumflex coronary artery, and 0.739 for the right coronary artery.
Conclusions: Real-time MCE-derived absolute MBF, β, and reserve values are feasible and accurate for detecting myocardial perfusion abnormalities as defined by SPECT.
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