Detection of coronary artery disease with perfusion stress echocardiography using a novel ultrasound imaging agent: two Phase 3 international trials in comparison with radionuclide perfusion imaging
Roxy Senior,Roxy Senior,Roxy Senior,Mark J. Monaghan,Michael L. Main,José Luis Zamorano,Klaus Tiemann,Luciano Agati,Neil J. Weissman,Allan L. Klein,Thomas H. Marwick,Masood Ahmad,Anthony N. DeMaria,Miguel Zabalgoitia,Harald Becher,Sanjiv Kaul,James E. Udelson,Frans J. Th. Wackers,Richard C Walovitch,Michael H. Picard +19 more
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TLDR
Imagify PSE was well-tolerated and its diagnostic performance in chest pain patients is comparable with SPECT perfusion imaging, which was equal for both modalities.Abstract:
Aims To determine if perfusion stress echocardiography (PSE) with Imagify™ (perflubutane polymer microspheres) is comparable to stress perfusion imaging using 99mTc single photon emission computed tomography (SPECT) for coronary artery disease (CAD) detection. PSE is a novel technique for evaluating myocardial perfusion. RAMP (real-time assessment of myocardial perfusion)-1 and -2 were international, Phase 3 trials that evaluated the ability of PSE with Imagify, to detect CAD.
Methods and results Chronic, stable, chest pain patients ( n = 662) underwent Imagify PSE and gated SPECT imaging at rest and during dipyridamole stress. Independent blinded cardiologists [three PSE readers per trial, and four SPECT readers (one for RAMP-1, three for RAMP-2)] interpreted images. CAD was defined by quantitative coronary angiography or 90-day outcome with clinical review. Accuracy, sensitivity, and specificity were evaluated using non-inferiority analysis (one-sided alpha = 0.025) compared with SPECT. SPECT results for RAMP-1 and -2 were: accuracy (70%, 67%), sensitivity (78%, 61%), and specificity (64%, 76%). Accuracy of all six PSE readers was non-inferior to SPECT (66–71%, P ≤ 0.004). Four demonstrated non-inferior sensitivity (68–77%, P ≤ 0.002), three demonstrated non-inferior specificity (72–88%, P ≤ 0.013). Three PSE readers (RAMP-2) were superior for sensitivity. Two PSE readers (RAMP-1) were superior for specificity. Area under the multi-reader receiver operating characteristics curve (0.72) was equal for both modalities. Majority of adverse events followed dipyridamole dosing, and were mild, transient, and required no treatment.
Conclusions Imagify PSE was well-tolerated. Its diagnostic performance in chest pain patients is comparable with SPECT perfusion imaging.read more
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Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography.
Roxy Senior,Harald Becher,Mark J. Monaghan,Luciano Agati,José Luis Zamorano,Jean-Louis Vanoverschelde,Petros Nihoyannopoulos +6 more
TL;DR: Based on the evidence, recommendations are proposed for the clinical use of contrast echocardiography, both for improving assessment of left ventricular structure and function compared with unenhanced echOCardiography and for the identification of myocardial perfusion.
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Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update.
Thomas R. Porter,Sharon L. Mulvagh,Sahar S. Abdelmoneim,Harald Becher,J. Todd Belcik,Michelle Bierig,Jonathan B. Choy,Nicola Gaibazzi,Linda D. Gillam,Rajesh Janardhanan,Shelby Kutty,Howard Leong-Poi,Jonathan R. Lindner,Michael L. Main,Wilson Mathias,Margaret M. Park,Roxy Senior,Flordeliza S. Villanueva +17 more
TL;DR: The aim of this conference is to provide a platform for the development of a new generation of scientists and clinicians to address the rapidly changing environment in which the authors live and work.
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Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography
Patricia A. Pellikka,Adelaide M. Arruda-Olson,Farooq A. Chaudhry,Ming-Hui Chen,Jane E. Marshall,Thomas R. Porter,Stephen G. Sawada +6 more
TL;DR: This document was prepared under the National Institutes responsibility of the a of the National Institu Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease.
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Imaging of perfusion using ultrasound
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Microbubbles as Ultrasound Contrast Agents for Molecular Imaging: Preparation and Application
TL;DR: Microbubbles are used for contrast ultrasound imaging as blood-pool agents in cardiology and radiology and their promise as targeted agents for molecular imaging is now being recognized.
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