Detection of myocardial perfusion abnormalities after a recent acute coronary syndrome by quantitative Levovist myocardial contrast echdcardiography:: Comparison with 99m Tc-Myoview SPECT imaging

BACKGROUND: The value of stress harmonic power Doppler imaging (HPDI) for the evaluation of myocardial perfusion has never been assessed in patients after acute coronary syndrome (ACS). OBJECTIVE: To evaluate the agreement between stress HPDI and single photon emission computed tomography (SPECT) imaging for the assessment of myocardial perfusion after unstable angina or myocardial infarction. PATIENTS AND METHODS: Thirty patients with a recent ACS underwent HPDI and SPECT. Images were obtained at rest and during dipyridamole infusion (0.56 mg/kg over 4 min). Apical two- and four-chamber views were used for HPDI. Ten myocardial segments were scored for myocardial perfusion. Semiquantitative and quantitative video intensity analysis with background subtraction were performed. RESULTS: Concordance by patients between quantitative HPDI and SPECT was 76% (kappa=0.40, Phi=0.46) for normal versus abnormal perfusion. When semiquantitative analysis was used, concordance was 72% (kappa=0.42, Phi=0.46). Agreement between methods was best in the left anterior descending artery territory for quantitative (80%) (kappa=0.60, Phi=0.60) and semiquantitative analysis (18%) (kappa=0.51, Phi=0.60) for normal versus abnormal perfusion. Discrepancies between HPDI and SPECT were most important in the circumflex territory, with a concordance of 59% (kappa=0.22) for identification of normal perfusion versus irreversible and reversible defects. CONCLUSIONS: These results suggest that HPDI can detect myocardial perfusion at rest and during pharmacological stress in patients after a recent ACS. Given the suboptimal agreement with SPECT, further advances are required before the routine use of contrast echocardiography is possible for the assessment of myocardial perfusion.