Detection of angiographically significant coronary artery disease with accelerated intermittent imaging after intravenous administration of ultrasound contrast material

Background Accelerated intermittent harmonic imaging (AII) is used to detec t myocardial perfusion abnormalities after intravenous injection of ultraso und contrast medium. A low mechanical index and frame rates of 10 to 20 Hz are used to allow simultaneous wall motion analysis. The purpose of this st udy was to determine whether the myocardial contrast enhancement achieved w ith All can be used to detect angiographically significant coronary artery disease during stress echocardiography. Methods We gave intravenous perfluorocarbon containing microbubbles to 45 p atients (total of 270 regions) during dobutamine (n = 27) or exercise (n = 18) stress testing with All. Quantitative angiography was performed on all patients after the stress echocardiograms were interpreted. Results Quantitative angiography showed >50% diameter stenosis of at least 1 vessel in 32 patients (total of 1 18 regions). There were visually eviden t contrast defects in 100 (85%) of these regions, and wall motion was abnor mal in 64 (54%). Overall, there was agreement between regional perfusion an d quantitative angiographic findings in 217 of the 270 regions (kappa = 0.6 1; 80% agreement). Agreement with findings at quantitative angiography was good for both dobutamine stress (kappa = 0.66; 83% agreement) and exercise (kappa = 0.53; 77% agreement). The greatest incremental benefit of All vers us wail motion was gained during dobutamine stress. The contrast studies de picted 90% of the regions supplied by a vessel with >50% stenosis, whereas wall motion depicted only 32% (P = .001). Conclusions The results of this study indicated that accelerated intermitte nt perfusion imaging during stress echocardiography can improve the sensiti vity of the study in detecting angiographically significant coronary artery disease, especially during dobutamine stress.