Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease

A large european multicenter study

Roxy Senior, Antonella Moreo, Nicola Gaibazzi, Luciano Agati, Klaus Tiemann, Bharati Shivalkar, Stephan Von Bardeleben, Leonarda Galiuto, Hervé Lardoux, Giuseppe Trocino, Ignasi Carrió, Dominique Le Guludec, Gianmario Sambuceti, Harald Becher, Paolo Colonna, Folkert Ten Cate, Ezio Bramucci, Ariel Cohen, Gianpaolo Bezante, Costantina Aggeli & 1 others Jaroslaw D. Kasprzak

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Objectives The purpose of this study was to compare sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) relative to coronary angiography (CA) for assessment of coronary artery disease (CAD). Background Small-scale studies have shown that myocardial perfusion assessed by SonoVue-enhanced MCE is a viable alternative to SPECT for CAD assessment. However, large multicenter studies are lacking. Methods Patients referred for myocardial ischemia testing at 34 centers underwent rest/vasodilator SonoVue-enhanced flash-replenishment MCE, standard 99mTc-labeled electrocardiography-gated SPECT, and quantitative CA within 1 month. Myocardial ischemia assessments by 3 independent, blinded readers for MCE and 3 readers for SPECT were collapsed into 1 diagnosis per patient per technique and were compared to CA (reference standard) read by 1 independent blinded reader. Results Of 628 enrolled patients who received SonoVue (71% males; mean age: 64 years; >1 cardiovascular [CV] risk factor in 99% of patients) 516 patients underwent all 3 examinations, of whom 161 (31.2%) had ≥70% stenosis (131 had single-vessel disease [SVD]; 30 had multivessel disease), and 310 (60.1%) had ≥50% stenosis. Higher sensitivity was obtained with MCE than with SPECT (75.2% vs. 49.1%, respectively; p <0.0001), although specificity was lower (52.4% vs. 80.6%, respectively; p <0.0001) for ≥70% stenosis. Similar findings were obtained for patients with ≥50% stenosis. Sensitivity levels for detection of SVD and proximal disease for ≥70% stenosis were higher for MCE (72.5% vs. 42.7%, respectively; p <0.0001; 80% vs. 58%, respectively; p = 0.005, respectively). Conclusions SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue® enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).

Original languageEnglish
Pages (from-to)1353-1361
Number of pages9
JournalJournal of the American College of Cardiology
Volume62
Issue number15
DOIs
Publication statusPublished - Oct 8 2013

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Sulfur Hexafluoride
Microbubbles
Single-Photon Emission-Computed Tomography
Multicenter Studies
Echocardiography
Coronary Artery Disease
Pathologic Constriction
Coronary Angiography
Myocardial Ischemia
Electrocardiography
contrast agent BR1
Dipyridamole
Vasodilator Agents
Exercise Test
Perfusion

Keywords

  • contrast echocardiography
  • ischemia
  • SonoVue

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease : A large european multicenter study. / Senior, Roxy; Moreo, Antonella; Gaibazzi, Nicola; Agati, Luciano; Tiemann, Klaus; Shivalkar, Bharati; Von Bardeleben, Stephan; Galiuto, Leonarda; Lardoux, Hervé; Trocino, Giuseppe; Carrió, Ignasi; Le Guludec, Dominique; Sambuceti, Gianmario; Becher, Harald; Colonna, Paolo; Ten Cate, Folkert; Bramucci, Ezio; Cohen, Ariel; Bezante, Gianpaolo; Aggeli, Costantina; Kasprzak, Jaroslaw D.

In: Journal of the American College of Cardiology, Vol. 62, No. 15, 08.10.2013, p. 1353-1361.

Research output: Contribution to journalArticle

Senior, R, Moreo, A, Gaibazzi, N, Agati, L, Tiemann, K, Shivalkar, B, Von Bardeleben, S, Galiuto, L, Lardoux, H, Trocino, G, Carrió, I, Le Guludec, D, Sambuceti, G, Becher, H, Colonna, P, Ten Cate, F, Bramucci, E, Cohen, A, Bezante, G, Aggeli, C & Kasprzak, JD 2013, 'Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease: A large european multicenter study', Journal of the American College of Cardiology, vol. 62, no. 15, pp. 1353-1361. https://doi.org/10.1016/j.jacc.2013.04.082
Senior, Roxy ; Moreo, Antonella ; Gaibazzi, Nicola ; Agati, Luciano ; Tiemann, Klaus ; Shivalkar, Bharati ; Von Bardeleben, Stephan ; Galiuto, Leonarda ; Lardoux, Hervé ; Trocino, Giuseppe ; Carrió, Ignasi ; Le Guludec, Dominique ; Sambuceti, Gianmario ; Becher, Harald ; Colonna, Paolo ; Ten Cate, Folkert ; Bramucci, Ezio ; Cohen, Ariel ; Bezante, Gianpaolo ; Aggeli, Costantina ; Kasprzak, Jaroslaw D. / Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease : A large european multicenter study. In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 15. pp. 1353-1361.
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abstract = "Objectives The purpose of this study was to compare sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) relative to coronary angiography (CA) for assessment of coronary artery disease (CAD). Background Small-scale studies have shown that myocardial perfusion assessed by SonoVue-enhanced MCE is a viable alternative to SPECT for CAD assessment. However, large multicenter studies are lacking. Methods Patients referred for myocardial ischemia testing at 34 centers underwent rest/vasodilator SonoVue-enhanced flash-replenishment MCE, standard 99mTc-labeled electrocardiography-gated SPECT, and quantitative CA within 1 month. Myocardial ischemia assessments by 3 independent, blinded readers for MCE and 3 readers for SPECT were collapsed into 1 diagnosis per patient per technique and were compared to CA (reference standard) read by 1 independent blinded reader. Results Of 628 enrolled patients who received SonoVue (71{\%} males; mean age: 64 years; >1 cardiovascular [CV] risk factor in 99{\%} of patients) 516 patients underwent all 3 examinations, of whom 161 (31.2{\%}) had ≥70{\%} stenosis (131 had single-vessel disease [SVD]; 30 had multivessel disease), and 310 (60.1{\%}) had ≥50{\%} stenosis. Higher sensitivity was obtained with MCE than with SPECT (75.2{\%} vs. 49.1{\%}, respectively; p <0.0001), although specificity was lower (52.4{\%} vs. 80.6{\%}, respectively; p <0.0001) for ≥70{\%} stenosis. Similar findings were obtained for patients with ≥50{\%} stenosis. Sensitivity levels for detection of SVD and proximal disease for ≥70{\%} stenosis were higher for MCE (72.5{\%} vs. 42.7{\%}, respectively; p <0.0001; 80{\%} vs. 58{\%}, respectively; p = 0.005, respectively). Conclusions SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue{\circledR} enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).",
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TY - JOUR

T1 - Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease

T2 - A large european multicenter study

AU - Senior, Roxy

AU - Moreo, Antonella

AU - Gaibazzi, Nicola

AU - Agati, Luciano

AU - Tiemann, Klaus

AU - Shivalkar, Bharati

AU - Von Bardeleben, Stephan

AU - Galiuto, Leonarda

AU - Lardoux, Hervé

AU - Trocino, Giuseppe

AU - Carrió, Ignasi

AU - Le Guludec, Dominique

AU - Sambuceti, Gianmario

AU - Becher, Harald

AU - Colonna, Paolo

AU - Ten Cate, Folkert

AU - Bramucci, Ezio

AU - Cohen, Ariel

AU - Bezante, Gianpaolo

AU - Aggeli, Costantina

AU - Kasprzak, Jaroslaw D.

PY - 2013/10/8

Y1 - 2013/10/8

N2 - Objectives The purpose of this study was to compare sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) relative to coronary angiography (CA) for assessment of coronary artery disease (CAD). Background Small-scale studies have shown that myocardial perfusion assessed by SonoVue-enhanced MCE is a viable alternative to SPECT for CAD assessment. However, large multicenter studies are lacking. Methods Patients referred for myocardial ischemia testing at 34 centers underwent rest/vasodilator SonoVue-enhanced flash-replenishment MCE, standard 99mTc-labeled electrocardiography-gated SPECT, and quantitative CA within 1 month. Myocardial ischemia assessments by 3 independent, blinded readers for MCE and 3 readers for SPECT were collapsed into 1 diagnosis per patient per technique and were compared to CA (reference standard) read by 1 independent blinded reader. Results Of 628 enrolled patients who received SonoVue (71% males; mean age: 64 years; >1 cardiovascular [CV] risk factor in 99% of patients) 516 patients underwent all 3 examinations, of whom 161 (31.2%) had ≥70% stenosis (131 had single-vessel disease [SVD]; 30 had multivessel disease), and 310 (60.1%) had ≥50% stenosis. Higher sensitivity was obtained with MCE than with SPECT (75.2% vs. 49.1%, respectively; p <0.0001), although specificity was lower (52.4% vs. 80.6%, respectively; p <0.0001) for ≥70% stenosis. Similar findings were obtained for patients with ≥50% stenosis. Sensitivity levels for detection of SVD and proximal disease for ≥70% stenosis were higher for MCE (72.5% vs. 42.7%, respectively; p <0.0001; 80% vs. 58%, respectively; p = 0.005, respectively). Conclusions SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue® enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).

AB - Objectives The purpose of this study was to compare sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) relative to coronary angiography (CA) for assessment of coronary artery disease (CAD). Background Small-scale studies have shown that myocardial perfusion assessed by SonoVue-enhanced MCE is a viable alternative to SPECT for CAD assessment. However, large multicenter studies are lacking. Methods Patients referred for myocardial ischemia testing at 34 centers underwent rest/vasodilator SonoVue-enhanced flash-replenishment MCE, standard 99mTc-labeled electrocardiography-gated SPECT, and quantitative CA within 1 month. Myocardial ischemia assessments by 3 independent, blinded readers for MCE and 3 readers for SPECT were collapsed into 1 diagnosis per patient per technique and were compared to CA (reference standard) read by 1 independent blinded reader. Results Of 628 enrolled patients who received SonoVue (71% males; mean age: 64 years; >1 cardiovascular [CV] risk factor in 99% of patients) 516 patients underwent all 3 examinations, of whom 161 (31.2%) had ≥70% stenosis (131 had single-vessel disease [SVD]; 30 had multivessel disease), and 310 (60.1%) had ≥50% stenosis. Higher sensitivity was obtained with MCE than with SPECT (75.2% vs. 49.1%, respectively; p <0.0001), although specificity was lower (52.4% vs. 80.6%, respectively; p <0.0001) for ≥70% stenosis. Similar findings were obtained for patients with ≥50% stenosis. Sensitivity levels for detection of SVD and proximal disease for ≥70% stenosis were higher for MCE (72.5% vs. 42.7%, respectively; p <0.0001; 80% vs. 58%, respectively; p = 0.005, respectively). Conclusions SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue® enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).

KW - contrast echocardiography

KW - ischemia

KW - SonoVue

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