Adenosine myocardial contrast echo in intermediate severity coronary stenoses: a prospective two-center study |
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Authors: | Christian Firschke Peter Andrássy Andre Z Linka Raymonde Busch Stefan Martinoff |
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Institution: | 1.Associate Professor of Medicine,?,Reichertshausen,Germany;2.Deutsches Herzzentrum,Technische Universit?t München,München,Germany;3.Institut für Medizinische Statistik und Epidemiologie,Technische Universit?t München,München,Germany;4.Abteilung für Kardiologie, Kantonsspital,Universit?t Basel,Basel,Switzerland |
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Abstract: | Background We sought to evaluate the role of adenosine myocardial contrast echocardiography (MCE) for the determination of functional
relevance of coronary stenoses with intermediate angiographic severity and compared the results to single photon imaging (SPECT).
We hypothezised that sole assessment of myocardial blood volume changes during adenosine on MCE would indicate functional
stensosis relevance when accompanied by increased myocardial oxygen consumption (MVO2).
Methods Fifty-seven patients with ≥1 coronary stenosis underwent adenosine MCE (ultraharmonic imaging) and exercise SPECT. On MCE,
myocardial blood volume was assessed and constant or increased myocardial opacification during adenosine coupled with increased
MVO2 was defined as normal and decreased opacification as abnormal.
Results Rate–pressure product significantly increased during adenosine in all patients due to reflex tachycardia following mild hypotension,
indicative of increased MVO2. Concordance between MCE and SPECT for the detection of reversible myocardial perfusion defects
was 89% (κ = 0.83). Comparison of regions between rest and during adenosine as opposed to comparison to remote regions of
the same stage was important for accurate assessment because concordance betweenn MCE and SPECT was less on separate assessment
at rest (73%, κ = 0.40) compared to stress (91%, κ = 0.81, P < 0.05) mainly due to territories scored normal on SPECT and abnormal on MCE.
Conclusions Assessment of myocardial blood volume changes during adenosine using MCE can be used for the determination of the functional
relevance of coronary stenoses of intermediate angiographic severity if MVO2 is increased during adenosine. |
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Keywords: | Coronary disease Contrast media Echocardiography |
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