Quantitative detection of myocardial ischaemia by stress echocardiography; a comparison with SPECT

AIMS: Real-time perfusion (RTP) adenosine stress echocardiography (ASE) can be used to visually evaluate myocardial ischaemia. The RTP power modulation technique angio-mode (AM), provides images for off-line perfusion quantification using Qontrast(® )software, generating values of peak signal intensity (A), myocardial blood flow velocity (β) and myocardial blood flow (Axβ). By comparing rest and stress values, their respective reserve values (A-r, β-r, Axβ-r) are generated. We evaluated myocardial ischaemia by RTP-ASE Qontrast(® )quantification, compared to visual perfusion evaluation with (99m)Tc-tetrofosmin single-photon emission computed tomography (SPECT). METHODS AND RESULTS: Patients admitted to SPECT underwent RTP-ASE (SONOS 5500) using AM during Sonovue(® )infusion, before and throughout adenosine stress, also used for SPECT. Visual myocardial perfusion and wall motion analysis, and Qontrast(® )quantification, were blindly compared to one another and to SPECT, at different time points off-line. We analyzed 201 coronary territories (left anterior descendent [LAD], left circumflex [LCx] and right coronary [RCA] artery territories) in 67 patients. SPECT showed ischaemia in 18 patients and 19 territories. Receiver operator characteristics and kappa values showed significant agreement with SPECT only for β-r and Axβ-r in all segments: area under the curve 0.678 and 0.665; P < 0.001 and < 0.01, respectively. The closest agreements were seen in the LAD territory: kappa 0.442 for both β-r and Axβ-r; P < 0.01. Visual evaluation of ischaemia showed good agreement with SPECT: accuracy 93%; kappa 0.67; P < 0.001; without non-interpretable territories. CONCLUSION: In this agreement study with SPECT, RTP-ASE Qontrast(® )quantification of myocardial ischaemia was less accurate and less feasible than visual evaluation and needs further development to be clinically useful.