HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Elhendy, A. Articles by Porter, T. R. Search for Related Content PubMed PubMed Citation Articles by Elhendy, A. Articles by Porter, T. R. Social Bookmarking                What's this?

Noninvasive Diagnosis of Coronary Artery Disease in Patients With Diabetes by Dobutamine Stress Real-Time Myocardial Contrast Perfusion Imaging

Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska

Address correspondence and reprint requests to Abdou Elhendy, MD, PhD, 982265 Nebraska Medical Center, Omaha, NE 68198-2265. E-mail: aelhendy{at}unmc.edu

OBJECTIVE—The aim of this study was to assess the accuracy of real-time myocardial contrast perfusion imaging (MCPI) during dobutamine stress in the diagnosis and localization of coronary artery disease (CAD) in patients with diabetes. Myocardial contrast echocardiography is a new technique that allows evaluation of myocardial perfusion. Its utility in diabetic patients has not been defined.

RESEARCH DESIGN AND METHODS—Dobutamine-atropine stress test was performed in conjunction with MCPI using Optison or Definity at rest and at peak stress in 128 patients with diabetes and suspected CAD who underwent coronary angiography within 1 month. CAD was defined as 50% stenosis in one or more coronary artery. MCPI was considered diagnostic of CAD in the presence of reversible perfusion abnormalities. The normalcy rate of MCPI was additionally determined in 18 asymptomatic nondiabetic patients with low probability.

RESULTS—CAD was detected in 101 (79%) patients by angiography. Reversible perfusion abnormalities were detected in 90 patients with and 13 patients without CAD. The overall sensitivity of MCPI was 89% (95% CI 83–95), specificity 52% (33–71), and accuracy 81% (75–88). Reversible abnormalities were detected in two or more vascular distributions in 44 of 56 patients with multivessel CAD and in 8 of 63 patients without (sensitivity 68%, specificity 87%, positive predictive value 84%, and accuracy 79%). Regional sensitivity was 75% (65–85) for left anterior descending CAD, 71% (60–83) for left circumflex, and 67% (55–78) for right CAD. MCPI was normal in 16 of the 18 patients with low clinical probability of CAD (normalcy rate 89%).

CONCLUSIONS—MCPI is a useful noninvasive technique for the diagnosis and localization of CAD in diabetic patients. The extent of perfusion abnormalities can identify patients with multivessel CAD with a moderate sensitivity and high specificity.

Abbreviations: CAD, coronary artery disease • DSE, dobutamine stress echocardiography • LAD, left anterior descending coronary artery • LCx, left circumflex coronary artery • MCPI, myocardial contrast perfusion imaging • RCA, right coronary artery

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				S. Kaul Myocardial Contrast Echocardiography: A 25-Year Retrospective Circulation, July 15, 2008; 118(3): 291 - 308. [Full Text] [PDF]

				J. J. Bax, S. E. Inzucchi, R. O. Bonow, J. D. Schuijf, M. R. Freeman, E. J. Barrett, and on behalf of the Global Dialogue Group for the Eva Cardiac Imaging for Risk Stratification in Diabetes Diabetes Care, May 1, 2007; 30(5): 1295 - 1304. [Full Text] [PDF]