Effect of intravenous contrast for left ventricular opacification and border definition on sensitivity and specificity of dobutamine stress echocardiography compared with coronary angiography in technically difficult patients

Background The study evaluates whether Optison used during dobutamine stres s echocardiography (DSE) will improve endocardial border definition and whe ther this will translate to an improvement in sensitivity and specificity o f the test in patients with poor echocardiographic windows. DSE is extremel y valuable in the workup of patients with coronary artery disease. The test is limited in patients with suboptimal endocardial border visualization. F requent studies have demonstrated improved endocardial border visualization with intravenous contrast agents at rest. Methods and Results We studied 229 patients: 112 had good rest echocardiogr aphy with no contrast and 117 had poor rest echocardiography with Optison i njection during DSE. Percentage of endocardial border visualization, wall t hickening, sensitivity, and specificity were compared in both groups, as wa s interobserver variability. Both groups were matched with respect to age, percentage of previous myocardial infarctions, resting wall motion abnormal ity, percentage of coronary stenosis, and number of diseased coronary arter ies. Optison significantly improved endocardial border visualization, espec ially at peak stress. The ability to measure wall thickening was significan tly higher in the contrast DSE group with suboptimal images versus the nonc ontrast group with optimal images (89% ability to measure wall thickening v s 71%, P = .01). This resulted in a comparable sensitivity (79% vs 71%, P = not significant [NS]), specificity (76% vs 82%, P = NS), and diagnostic ac curacy (80% vs 76%, P = NS). Agreement on test interpretation was higher am ong 3 observers in contrast DSE versus noncontrast DSE groups (79% vs 69%, P = .01). Conclusions In patients with poor echocardiographic windows, the use of Opt ison during DSE improves endocardial border visualization, which translates to a comparable sensitivity and specificity to noncontrast DSE tests in pa tients with good echocardiographic windows.