J Cardiovasc Ultrasound.  2010 Jun;18(2):45-51. 10.4250/jcu.2010.18.2.45.

Comparison of Myocardial Contrast Echocardiography Versus Rest Sestamibi Myocardial Perfusion Imaging in the Early Diagnosis of Acute Coronary Syndrome

• Kang SJ
• Kang DH
• Song JM
• Song JK
• Park SW
• Park SJ

• KMID: 2135437
• DOI: http://doi.org/10.4250/jcu.2010.18.2.45

Abstract

BACKGROUND
It remains unclear whether myocardial contrast echocardiography (MCE) is as accurate as myocardial perfusion imaging with technetium-99m sestamibi (MPI) for the diagnosis of acute coronary syndrome (ACS). We sought to directly compare the diagnostic accuracy of MCE with resting MPI in a head-to-head fashion.
METHODS
We prospectively enrolled 98 consecutive patients (mean age; 59+/-9 years, 68 males) who presented to the emergency department with chest pain suggestive of acute myocardial ischemia. Early MCE was performed by using continuous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) during intermittent power Doppler harmonic imaging. Myocardial perfusion defects observed in at least one coronary territory were considered positive. Sestamibi was injected immediately after MCE and MPI was obtained within 6 hours of tracer injection.
RESULTS
ACS was confirmed in 67 patients. There were 32 patients with acute myocardial infarction (AMI) and 35 patients with unstable angina requiring urgent revascularization. The sensitivities of MCE and MPI for the diagnosis of ACS were 72% and 61%, respectively, which were significantly higher than those of ST segment change (24%, p<0.001 vs. MCE and vs. MPI) and troponin I (27%, p<0.001 vs. MCE and vs. MPI), with similar specificities of 90% to 100%. On a receiveroperating characteristics curve demonstrating diagnostic accuracy for ACS, the area under the curve of MCE was significantly larger than that of MPI (0.86 vs. 0.77, respectively; p=0.019).
CONCLUSION
MCE and MPI overcome the low sensitivity of routine triage tests for detecting ACS, and MCE is more accurate than MPI for the diagnosis of ACS in the emergency department.

Keyword

Myocardial contrast echocardiography; Myocardial perfusion imaging; Acute coronary syndrome

MeSH Terms

Acute Coronary Syndrome
Angina, Unstable
Chest Pain
Early Diagnosis
Echocardiography
Emergencies
Glucose
Humans
Myocardial Infarction
Myocardial Ischemia
Myocardial Perfusion Imaging
Perfusion
Prospective Studies
Triage
Troponin I
Glucose
Troponin I

Figure

• 

  Fig. 1 Myocardial contrast echocardiography using power harmonic Doppler imaging with a dual-frame triggering (A). Left, perfusion frame was generated when the first packet of pulses encountered microbubbles in the myocardium and destroyed them. Right, post-destruction frame was obtained approximately 50 milliseconds later demonstrating the myocardium which was void of microbubbles. Apical perfusion defects are observed in the first perfusion imaging frame with 1 : 5 trigger rate. There was moderately decreased perfusion of the left anterior descending artery territory on myocardial perfusion imaging and critical stenosis of the left anterior descending artery on coronary angiography (B).

• 

  Fig. 2 Receiver-operating characteristics curve comparing the accuracy of myocardial contrast echocardiography (MCE) and myocardial perfusion imaging (MPI) for diagnosis of acute coronary syndrome (ACS). The area under the curve (AUC) of MCE was significantly larger than that of MPI (0.86 and 0.77, p=0.019).

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