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European Journal of Echocardiography Advance Access published online on April 14, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen136
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Contrast-enhanced three-dimensional dobutamine stress echocardiography: between Scylla and Charybdis?

Boudewijn J. Krenning*, Attila Nemes, Osama I.I. Soliman, Wim B. Vletter, Marco M. Voormolen, Johan G. Bosch, Folkert J. ten Cate, Jos R.T.C. Roelandt and Marcel L. Geleijnse

Department of Cardiology, Erasmus MC, Thoraxcenter, Room Ba 316, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Received 21 October 2007; received in revised form 8 February 2008; accepted after revision 9 March 2008.

* Corresponding author. Tel: +31 10 7040704; fax: +31 10 4110419. E-mail address: b.krenning{at}erasmusmc.nl


  Abstract

Aims: Real-time three-dimensional echocardiography (RT3DE) allows quick volumetric scanning of the left ventricle (LV). We evaluated the diagnostic accuracy of contrast-enhanced stress RT3DE for the detection of coronary artery disease (CAD) in comparison with coronary arteriography as the reference technique.

Methods and results: Forty-five consecutive patients (age 59 ± 10, 31 males) referred for coronary angiography were examined by contrast-enhanced RT3DE. Wall motion analysis was performed off-line by dedicated software. New or worsening wall motion abnormalities were detected in 17 of 28 patients with significant CAD (sensitivity 61%), and in two of 17 patients without significant CAD (specificity 88%). The sensitivity for detection of single-vessel CAD was 8/15 patients (53%), for two-vessel CAD 4/6 (67%), and for three-vessel CAD 5/7 (71%). In 35 patients, comparison with conventional RT3DE was available. The image quality index at rest improved from 2.5 ± 1.2 to 3.2 ± 1.0 (P < 0.001) with contrast and at peak stress from 2.3 ± 1.2 to 3.1 ± 1.0 (P < 0.001). Interobserver agreement on the diagnosis of myocardial ischaemia improved from 26 of 35 studies (74%, {kappa} = 0.44) with conventional stress RT3DE to 30 of 35 studies (86%, {kappa} = 0.69) with contrast-enhanced stress RT3DE. Sensitivity increased from 50 to 55% and specificity from 69 to 85% with contrast-enhanced stress RT3DE in this subset of patients.

Conclusion: Despite some important practical and theoretical benefits, contrast-enhanced stress RT3DE currently has only moderate diagnostic sensitivity due to several technical limitations as temporal and spatial resolution.

Keywords: Dobutamine; Stress; Three-dimensional echocardiography; Contrast


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