Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses

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Abstract

Aim. To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses.

Materials and methods. Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (50–75%) and 33 – over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed.

Results. Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (50–75%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively

Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.

About the authors

L. S. Atabaeva

Myasnikov Insitute of Clinical Cardiology, National Medical Research Center for Cardiology

Author for correspondence.
Email: atabaeva_lina@mail.ru
ORCID iD: 0000-0003-1911-1256

врач функциональной диагностики, аспирант отд. ультразвуковых методов исследования

Russian Federation, Moscow

M. A. Saidova

Myasnikov Insitute of Clinical Cardiology, National Medical Research Center for Cardiology

Email: atabaeva_lina@mail.ru
ORCID iD: 0000-0002-3233-1862

д.м.н., проф., рук. отд. ультразвуковых методов исследования

Russian Federation, Moscow

V. N. Shitov

Myasnikov Insitute of Clinical Cardiology, National Medical Research Center for Cardiology

Email: atabaeva_lina@mail.ru

мл. науч. сотр. отд. ультразвуковых методов исследования

Russian Federation, Moscow

I. I. Staroverov

Myasnikov Insitute of Clinical Cardiology, National Medical Research Center for Cardiology

Email: atabaeva_lina@mail.ru

д.м.н., проф., рук. отд. неотложной кардиологии

Russian Federation, Moscow

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2. Fig. 1. The protocol of the ISS.

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3. Fig. 2. Quality of visualization of LV segments with standard stress echocardiography and ICSE.

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4. Fig. 5. Sensitivity, specificity and accuracy of standard stress echocardiography and MKSE with “borderline” (50–75%) CA stenoses. Taking into account PRK, measured in 12 out of 39 CAs, it can be noted that the sensitivity, specificity and accuracy of standard stress echocardiography increased by 8, 10 and 9%, and MKSE - by 12, 6 and 11%. Note. H - sensitivity, C - specificity, T - accuracy of the method.

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5. Fig. 6. The sensitivity, specificity and accuracy of standard stress echocardiography and MKSE with stenosis of more than 75%.

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6. Fig. 3. Four-chamber apical position: comparison of standard stress echocardiography and MCE in a patient with poor visualization of LV endocardium. When a contrast agent was administered, a zone of hypokinesia was detected along the side wall of the left ventricle (indicated by arrows), which was not clearly defined with standard stress echocardiography.

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7. Fig. 4. MCSE in a patient with stenosis of the anterior descending (80%) and envelope (90%) of the spacecraft. Apical three-chamber position: no disturbances of local contractility were detected at rest, a limited area of reduced perfusion was determined in the area of the apex of the LV (indicated by an arrow). At the maximum load, the appearance of zones of hypoakinesia along the anterior septum and posterolateral walls of the left ventricle with a marked decrease in perfusion, exceeding the zone of violation of local contractility (indicated by arrows) was noted.

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