Real-time dobutamine stress myocardial contrast echocardiography for detecting coronary artery disease: Correlating abnormal wall motion and disturbed perfusion

Kuan R. Chiou, Wei Chun Huang, Shoa L. Lin, Pu L. Hsieh, Chun Peng Liu, Daw Guey Tsay, Hung Ting Chiang

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Background: Real-time myocardial contrast echocardiography (MCE) makes possible the simultaneous visualization of changes in perfusion imaging and wall motion. Objectives: To assess the accuracy of real-time MCE for detecting the presence and extent of coronary artery disease (CAD), and to evaluate the correlation between wall motion and myocardial perfusion by visual examination. Methods: A total of 140 consecutive patients without resting wall motion abnormalities were screened to undergo dobutamine stress MCE with power modulation and coronary angiography. Significant coronary disease was defined by the quantification of over 50% stenosis in a major epicardial vessel. The visual identification of wall motion and myocardial perfusion abnormalities was determined by blind review. Results: Eight patients were excluded due to suboptimal images (feasibility 94.3%). Myocardial contrast enhancement analysis and wall motion analysis were similar in terms of sensitivity (81.2% versus 83.5%, respectively) and specificity (76.5% versus 80.9%, respectively) in detecting the presence of CAD. Myocardial contrast enhancement analysis tended to have a greater sensitivity than wall motion analysis in detecting the ischemic extent over multiple vascular territories among patients with multiple-vessel disease (sensitivity 83.8% versus 71.4% [P=0.09], and abnormal segment length 54.7±21.1% versus 48.9±24.7% [P=0.03] for myocardial contrast enhancement and wall motion analysis, respectively). There was good concordance between the presence of myocardial ischemia and wall motion abnormality for the segment-by-segment analysis (89.7% agreement, kappa = 0.745). The correlation of the wall motion score and perfusion score at peak stress was also good (r=0.793, P=0.015). Conclusions: Dobutamine stress MCE with power modulation is similar in sensitivity and specificity to wall motion analysis for detecting the presence of CAD. However, it provides greater sensitivity in evaluating the extent of ischemia in patients with multiple-vessel disease.

Original languageEnglish
Pages (from-to)1237-1243
Number of pages7
JournalCanadian Journal of Cardiology
Issue number12
Publication statusPublished - Oct 1 2004
Externally publishedYes



  • Contrast media
  • Coronary artery disease
  • Dobutamine echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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