(Circulation. 2000;102:55.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Assessment of Myocardial Perfusion by Harmonic Power Doppler Imaging at Rest and During Adenosine Stress
Comparison With 99mTc-Sestamibi SPECT Imaging
From the Department of Internal Medicine, Division of Cardiology, UT Southwestern and Dallas VA Medical Centers, Dallas, Tex.
Correspondence to Paul A. Grayburn, MD, Division of Cardiology (111A), VA Medical Center, 4500 S Lancaster Rd, Dallas, TX 75216. E-mail grayburn{at}ryburn.swmed.edu
Background—Harmonic power Doppler imaging (HPDI) is a novel technique for assessing myocardial perfusion by contrast echocardiography in humans. The purpose of this study was to compare myocardial perfusion by HPDI with that obtained by 99mTc-sestamibi single photon emission computed tomography (SPECT) during rest and pharmacological stress.
Methods and Results—HPDI was performed on 123 patients who were
referred for SPECT imaging for known or suspected coronary
artery disease. Images were obtained at baseline and during
adenosine infusion (0.14 mg ·
kg-1 ·
min-1x6 minutes) in 3 apical views.
Myocardial perfusion by HPDI was graded for each coronary
territory as absent, patchy, or full. The persistence of absent or
patchy myocardial perfusion by HPDI between rest and adenosine
was interpreted as a fixed defect, whereas any decrease in perfusion
grade was interpreted as a reversible defect. Overall concordance
between HPDI and SPECT was 83 (81%) of 103 for normal versus abnormal
perfusion. Agreement between the 2 methods for each of the 3
coronary territories was 81% (
=0.57) for the left anterior
descending artery, 76% (=0.52) for the right coronary
artery, and 72% (=0.40) for the left circumflex artery.
Discrepancies between the 2 techniques were most notable in the
circumflex territory, where fixed defects were observed in 33% by HPDI
but in only 14% by SPECT (
2=15.8,
P=0.0001).
Conclusions—This study demonstrates that HPDI can reliably detect myocardial perfusion during pharmacological stress, although there was a significantly higher number of falsely abnormal results in the circumflex territory.
Key Words: contrast media • echocardiography • perfusion • stress • tomography • adenosine
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