Diagnostic significance of myocardial and multimodal contrast exercise stress echocardiography in the detection of hemodynamically significant coronary artery stenosis in stable angina pectoris

Aim. To evaluate the diagnostic significance of myocardial contrast stress echocardiography (MCSE) and multimodal contrast stress echocardiography (MMSE) with dosed exercise in detecting hemo­dynamically significant coronary artery stenosis in patients with stable coronary heart disease (CAD) without impaired regional left ventricular contractility at rest.

Material and methods. MCSE and MMSE were performed in 61 pa­­tients with suspected or stable CAD (mean age, 62,9±8,9 years). All patients underwent coronary angiography. During MCSE, perfusion and regional contractility were assessed. With MMSE, regional contractility was assessed. Sensitivity, specificity, and positive (LR+) and negative (LR-) likelihood ratios for MCSE and MMSE were assessed in com­parison with coronary angiography.

Results. The sensitivity of MCSE with perfusion assessment was 82% (CI, 67-92%) with specificity of 70% (35-92%), LR+ — 2,74, LR- — 0,26. Sensitivity of MCSE with assessment of perfusion and regional contractility was 67% (50-81%) with specificity of 90% (65-99%), LR+ — 6,67, LR- — 0,37. The sensitivity of MCSE with an estimate of regional contractility of 74% (58-87%) with a specificity of 90% (56-98%), LR+ — 7,4, LR- — 0,28. The sensitivity of MMSE in the mode of cavitary and myocardial contrasting was 72% (55-85%) with a specificity of 90% (56-99%), LR+ — 7,18, LR- — 0,31.

Conclusion. MCSE with an assessment of regional contractility and MMSE are of diagnostic importance in the detection of CAD, a positive result of which increases the post-test probability of hemodynamically significant coronary artery stenosis. A positive result of MCSE with dosed exercise with isolated perfusion assessment does not have a diagnostically significant effect on the post-test probability of CAD.

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