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Parametric quantification of myocardial ischaemia using real‐time perfusion adenosine stress echocardiography images, with SPECT as reference method
Author(s) -
Gudmundsson P.,
Shahgaldi K.,
Winter R.,
Dencker M.,
Kitlinski M.,
Thorsson O.,
Ljunggren L.,
Willenheimer R.
Publication year - 2010
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/j.1475-097x.2009.00901.x
Subject(s) - medicine , perfusion , nuclear medicine , single photon emission computed tomography , blood flow , thallium , cardiology , emission computed tomography , ischemia , myocardial perfusion imaging , perfusion scanning , radiology , inorganic chemistry , chemistry
Summary Background: Real‐time perfusion (RTP) adenosine stress echocardiography (ASE) can be used to visually evaluate myocardial ischaemia. The RTP power modulation technique, provides images for off‐line parametric perfusion quantification using Qontrast ® software. From replenishment curves, this generates parametric images of peak signal intensity (A), myocardial blood flow velocity (β) and myocardial blood flow (Axβ) at rest and stress. This may be a tool for objective myocardial ischaemia evaluation. We assessed myocardial ischaemia by RTP‐ASE Qontrast ® ‐generated images, using 99mTc‐tetrofosmin single‐photon emission computed tomography (SPECT) as reference. Methods: Sixty‐seven patients admitted to SPECT underwent RTP‐ASE (SONOS 5500) during Sonovue ® infusion, before and throughout adenosine stress, also used for SPECT. Quantitative off‐line analyses of myocardial perfusion by RTP‐ASE Qontrast ® ‐generated A, β and Axβ images, at different time points during rest and stress, were blindly compared to SPECT. Results: We analysed 201 coronary territories [corresponding to the left anterior descendent (LAD), left circumflex (LCx) and right coronary (RCA) arteries] from 67 patients. SPECT showed ischaemia in 18 patients. Receiver operator characteristics and kappa values showed that A, β and Axβ image interpretation significantly identified ischaemia in all territories (area under the curve 0·66–0·80, P = 0·001–0·05). Combined A, β and Axβ image interpretation gave the best results and the closest agreement was seen in the LAD territory: 89% accuracy; kappa 0·63; P <0·001. Conclusion: Myocardial isachemia can be evaluated in the LAD territory using RTP‐ASE Qontrast ® ‐generated images, especially by combined A, β and Axβ image interpretation. However, the technique needs improvements regarding the LCx and RCA territories.