A Randomized Cross-Over Study for Evaluation of the Effect of Image Optimization With Contrast on the Diagnostic Accuracy of Dobutamine Echocardiography in Coronary Artery Disease
| Autor: | William A. Zoghbi, Juan Carlos Plana, Robert Davis, Issam Mikati, Hisham Dokainish, Nasser Lakkis, John M. Abukhalil, Brian C. Hetzell |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty media_common.quotation_subject Stress testing Myocardial Ischemia Contrast Media Hemodynamics Coronary Artery Disease Coronary Angiography law.invention Coronary artery disease Randomized controlled trial Predictive Value of Tests law Internal medicine Image Interpretation Computer-Assisted medicine Humans Contrast (vision) Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study Aged media_common Aged 80 and over Fluorocarbons Cross-Over Studies business.industry Middle Aged Image Enhancement medicine.disease Texas Crossover study Radiology Nuclear Medicine and imaging Predictive value of tests Cardiology Female Radiology Cardiology and Cardiovascular Medicine business Echocardiography Stress Endocardium |
| Zdroj: | JACC: Cardiovascular Imaging. 1:145-152 |
| ISSN: | 1936-878X |
| DOI: | 10.1016/j.jcmg.2007.10.014 |
| Popis: | ObjectivesThe purpose of this study was to evaluate whether the addition of a contrast agent to dobutamine stress echocardiography (DSE) improves its diagnostic accuracy for coronary artery disease (CAD) and to determine the effect of image quality on the diagnostic impact of contrast agent use in this setting.BackgroundContrast agents can improve endocardial border definition. To date, however, there are no randomized trials that have evaluated the impact of contrast agent use on the accuracy of DSE.MethodsPatients referred for stress testing with dobutamine echocardiography underwent 2 DSE studies: 1 with and 1 without a contrast agent, at least 4 h apart in a randomized order and within a 24-h period.ResultsA total of 101 patients underwent both DSE studies. Similar hemodynamics were achieved during the 2 stress testing sessions. The use of a contrast agent improved the percentage of segments adequately visualized at baseline (from 72 ± 24% to 95 ± 8%) and more so at peak stress (67 ± 28% to 96 ± 7%); both p < 0.001. Interpretation of wall motion with high confidence also increased with contrast agent use from 36% to 74% (p < 0.001). Segment visualization with the use of a contrast agent improved in all views, but was more pronounced in the apical views. In unenhanced DSE, 36% of studies were normal, 51% had ischemia, and 8% were uninterpretable—all of which became interpretable with the use of a contrast agent. When compared with angiography (n = 92; 55 patients with CAD), accurate detection of ischemia was higher with contrast-enhanced studies versus nonenhanced studies (p = 0.02). As endocardial visualization and confidence of interpretation decreased in unenhanced studies, a greater impact of the use of a contrast agent on DSE accuracy was observed (p < 0.01).ConclusionsDuring dobutamine stress echocardiography, contrast agent administration improves endocardial visualization at rest and more so during stress, leading to a higher confidence of interpretation and greater accuracy in evaluating CAD. The lesser the endocardial border visualization, the higher the impact of contrast echocardiography on accuracy. |
| Databáze: | OpenAIRE |
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