ORIGINAL ARTICLE Diagnosis of ischaemic heart disease by myocardial contrast echocardiography during supine bicycle stress

Abstract

Introduction:
Myocardial contrast echocardiography (MCE) is a new imaging modality for diagnosing ischaemic heart disease (IHD).
Aim:
The aim of this study was to assess 1) the feasibility of MCE during supine bicycle stress and 2) the value of this method in the diagnosis of IHD.
Methods:
Supine bicycle stress was performed in 44 consecutive patients (pts) referred for coronary angiography with an intermediate pre-test probability of IHD. MCE was carried out at peak stress and during recovery (once the heart rate returned to the pre-exercise value). During MCE an ultrasound contrast agent (Sonovue®) was administered intravenously in a continuous mode using an infusion pump (BR-INF 100, Bracco Research). The acquired images were qualitatively assessed for perfusion and wall motion abnormalities. The 18-segment division of the left ventricle was used in the analysis. Coronary angiography was performed in all pts within 15 days of the exercise test. A quantitative analysis of coronary artery stenoses was carried out using the CAAS system.
Results:
MCE could not be performed in 2 pts due to technical difficulties. Coronary angiography revealed significant coronary artery stenosis in 25 pts. The sensitivity and specificity of MCE in the diagnosis of IHD were 92.0% and 82.4%, respectively. The positive and negative predictive values were found to be 88.5% and 87.5%, respectively, while the agreement between coronary angiography and MCE was 88.1% (κ=0.75).
Conclusions:
MCE during supine bicycle stress and continuous intravenous administration of an ultrasound contrast agent is a feasible technique and allows accurate diagnosis of IHD in pts in whom the pre-test probability of the disease is intermediate.