Cardiovascular Disease Institute of Xuzhou Medical College, Xuzhou, China.
Clin Cardiol. 2013 Aug;36(8):468-74. doi: 10.1002/clc.22142. Epub 2013 Jun 10.
Real-time (RT) myocardial contrast echocardiography (MCE) is a novel method for the assessment of regional myocardial perfusion. We sought to evaluate the feasibility and diagnostic accuracy of quantitative RT-MCE in predicting significant coronary stenosis, with reference to quantitative coronary angiography.
RT-MCE can identify anatomically significant coronary artery stenosis in selected patients. RT-MCE is probably an effective method for detection of angiographically significant coronary artery stenosis.
Thirty-five patients (mean age, 59.94 ± 10.63 years; 25 males) scheduled for coronary angiography underwent RT-MCE at rest, and shortly afterward underwent gated single-photon emission computed tomography (gated-SPECT). Coronary angiography was performed within 1 week after RT-MCE in all patients. The observing indexes included the images of RT-MCE that were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the Q-Lab software. The sensitivity and specificity of RT-MCE for quantitative detection of coronary artery disease (CAD) were obtained. The receiver operator characteristic (ROC) curves were used to assess the differences of accuracy in ischemic segments with A, β and A × β respectively. The sensitivity and specificity of gated-SPECT and RT-MCE for assessment of CAD were calculated using a 4-score method.
A total of 513 segments among 595 segments in 35 patients were obtained. The cutoffs for A, β and A × β were 4.58, 0.64, and 2.73, and the sensitivity and specificity of quantitative RT-MCE for detection of CAD were 86.0%, 80.2%, 88.9%, and 84.1%, 64.6%, 79.9%, respectively. Meanwhile, the sensitivity and specificity of semiquantitative analysis for assessment of CAD were 66.7% and 61.8%. The ROC curve area of A and A × β was 0.91 and 0.90 in the middle segments. The ROC area of A was 0.52 in the base segments. The sensitivity and specificity of gated-SPECT for assessment of CAD were 84.8% and 82.7%, respectively. The sensitivity of multi-indexes RT-MCE increased. The sensitivity was 89.1%, 90.4%, and 96.3% by A + β, A + A × β, and β + A × β.
Quantitative RT-MCE is an effective method for the detection of coronary artery stenosis. Quantitative RT-MCE is segmented for assessment to ischemic myocardium. RT-MCE with multi-indexes has a valuable application for assessment of CAD surpassing SPECT.
实时（RT）心肌对比超声心动图（MCE）是一种评估局部心肌灌注的新方法。我们旨在评估定量 RT-MCE 预测有意义的冠状动脉狭窄的可行性和诊断准确性，并参考定量冠状动脉造影。
RT-MCE 可在选定的患者中识别解剖意义上的冠状动脉狭窄。RT-MCE 可能是检测有意义的冠状动脉狭窄的有效方法。
35 名患者（平均年龄 59.94±10.63 岁；男性 25 名）计划行冠状动脉造影，在休息时行 RT-MCE，随后行门控单光子发射计算机断层扫描（门控-SPECT）。所有患者均在 RT-MCE 后 1 周内行冠状动脉造影。观察指标包括使用 Q-Lab 软件从心肌灌注微泡再填充曲线定量分析 RT-MCE 图像。获得 RT-MCE 定量检测冠状动脉疾病（CAD）的灵敏度和特异性。使用接收者操作特征（ROC）曲线评估分别使用 A、β和 A×β评估缺血节段的准确性差异。使用 4 分法计算门控-SPECT 和 RT-MCE 评估 CAD 的灵敏度和特异性。
在 35 名患者的 595 个节段中，共获得 513 个节段。A、β和 A×β的截断值分别为 4.58、0.64 和 2.73，定量 RT-MCE 检测 CAD 的灵敏度和特异性分别为 86.0%、80.2%、88.9%和 84.1%、64.6%、79.9%。同时，半定量分析评估 CAD 的灵敏度和特异性分别为 66.7%和 61.8%。A 和 A×β 的 ROC 曲线面积在中间节段为 0.91 和 0.90。A 的 ROC 曲线面积在基底节段为 0.52。门控-SPECT 评估 CAD 的灵敏度和特异性分别为 84.8%和 82.7%。多指标 RT-MCE 的灵敏度增加。A+β、A+A×β 和β+A×β 的灵敏度分别为 89.1%、90.4%和 96.3%。
定量 RT-MCE 是检测冠状动脉狭窄的有效方法。定量 RT-MCE 用于评估缺血心肌。多指标 RT-MCE 分段评估 CAD 的应用价值超过 SPECT。
