Quantitative Myocardial Contrast Supine Bicycle Stress Echocardiography for Detection of Coronary Artery Disease

Background: If compared with two‐dimensional echocardiography (2 DE ), quantitative myocardial contrast echocardiography ( MCE ) improves detection of coronary artery disease ( CAD ) during pharmacological stress, but there is paucity of data regarding quantitative MCE performed during supine bicycle stress. Objectives: To determine the feasibility and accuracy of quantitative MCE and assess its incremental benefit over 2 DE for detection of CAD during supine bicycle stress. Methods: Sixty‐one consecutive patients (47 males, 14 females, mean age 57 ± 12 years) with suspected CAD , who were scheduled for coronary angiography, underwent 2 DE and MCE supine bicycle stress. The diagnosis of obstructive CAD (≥50% stenosis) was based on inducible wall‐motion and myocardial perfusion abnormalities. For quantitative myocardial perfusion analysis, A, β, and Aβ reserve were derived from myocardial contrast replenishment curves. Results: Quantitative coronary angiography revealed ≥50% stenosis in 41, ≥70% stenosis in 18, single vessel disease in 24, and multivessel disease in 17 patients. If compared with 2 DE , quantitative MCE was more sensitive (71% vs. 93%; P < 0.05) and more accurate (74% vs. 89%; P < 0.05) to detect obstructive CAD . The sensitivity of 2 DE and quantitative MCE was 61% and 91% (P < 0.05) in 50–69% stenosis, and 63% and 92% (P < 0.05) in single vessel disease. No difference in sensitivity between 2 DE and quantitative MCE was found in subjects with ≥70% stenosis (83% vs. 94%, P =  NS ) and multivessel disease (82% vs. 94%, P =  NS ). Conclusions: Quantitative MCE enhances sensitivity and accuracy of supine bicycle stress 2 DE for detection of obstructive CAD , and this incremental benefit is especially present in less severe disease.