Application of myocardial contrast echocardiography for the perfusion assessment in patients with end-stage renal failure--comparison with coronary angiography

Abstract

Background: 39 end-stage renal disease (ESRD) patients undergoing elective coronary angiography (CA) were studied.

Method: Myocardial contrast echocardiography (MCE) for the perfusion assessment was done prior to CA. The left ventricle was divided into three regions supplied by left anterior descending (LAD) circumflex (Cx) and right coronary artery (RCA). Comparison between MCE and CA was performed on two levels: presence of any perfusion defect by any significant coronary artery stenosis (CAS) in a particular patient, any perfusion defect-by-vessel analysis.

Results: Significant coronary artery disease was revealed on CA in 18 (46%) patients. 28 (72%) of the patients had perfusion defects on MCE. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) of MCE for the presence of any significant CAS in a given patient were 94, 76, 77 and 94% respectively. The best agreement between the presence of the perfusion defect on MCE and CAS was found for RCA: sensitivity 89%, specificity 87%, PPV 67%, NPV 96%, the worst for LAD: 71, 71, 53 and 91% respectively.

Conclusion: Our preliminary results indicate that MCE is of a good accuracy for ruling out the presence of a significant CAS in patients with ESRD. Diagnostic performance of MCE seems to be different in respect of analyzed region of the left ventricle.