Myocardial contrast echocardiography

Myocardial contrast echocardiography

Myocardial contrast echocardiography (MCE) has been used in the assessment of myocardial viability. Downside of myocardial contrast echocardiography is the cost of ultrasound contrast agent (UCA). Intravenous administration of UCA improves the visualisation of myocardial segments and enables the assessment of perfusion. Myocardial segments with normal perfusion and those with patchy perfusion are considered to be viable. Those segments which have no perfusion are taken as non viable myocardial segments. UCA consists of ultrasonic microbubbles. A recent study compared MCE with gated single photon emission computed tomography (SPECT) for detection of significant coronary artery disease [1]. The study had enrolled 628 patients, with more than one cardiovascular risk factors in 99%. 516 patients underwent MCE, (99m)Tc-labeled electrocardiography-gated SPECT and quantitative coronary angiography. About one third had coronary stenosis of 70% or more. 131 had single vessel disease and 30 had multivessel disease. 310 had coronary stenosis of 50% or more. They documented higher sensitivity for myocardial contrast echocardiography than SPECT, though with lower specificity. An accompanying editorial was slightly skeptical about the role of MCE [2]. They mention that the study missed one of its primary end points in the form of noninferiority of specificity for detection of 70% or more coronary stenosis.

References

  1. Senior R, Moreo A, Gaibazzi N, Agati L, Tiemann K, Shivalkar B, von Bardeleben S, Galiuto L, Lardoux H, Trocino G, Carrió I, Le Guludec D, Sambuceti G, Becher H, Colonna P, Ten Cate F, Bramucci E, Cohen A, Bezante G, Aggeli C, Kasprzak JD. Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease: a large European multicenter study. J Am Coll Cardiol. 2013 Oct 8;62(15):1353-61. (Open access).
  2. Thomas JD. Myocardial contrast echocardiography perfusion imaging: still waiting after all these years. J Am Coll Cardiol. 2013 Oct 8;62(15):1362-4.

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