J Zehelein

Publications (2)1.94 Total impact

• Article: Real-time myocardial contrast echocardiography for the detection of stress-induced myocardial ischemia. Comparison with 99mTc-sestamibi single photon emission computed tomography.

  A-E Dubart, K G Carvalho da Silva, G Korosoglou, R Bekeredjian, A Hansen, S Hardt, M Rosenberg, N Ferrari, B Hoerig, J Zehelein, H Kuecherer
  [show abstract] [hide abstract]
  ABSTRACT: Real-time contrast echocardiography (MCE) is a new promising technique for assessing myocardial perfusion. The purpose of this study was to test whether realtime MCE can be used to detect functionally significant coronary artery stenosis in patients with known or suspected coronary artery disease. Myocardial contrast echocardiographic studies were compared with nearly simultaneous 99mTc-sestamibi single photon emission computed tomography (SPECT) as a clinical standard reference to evaluate regional myocardial perfusion defects. Real-time MCE based on continuous infusion of Optison (8-10 ml/h) was performed in 66 patients during standard 99mTc-SPECT dipyridamole (0.56 mg/kg x 4 min) stress testing. Images were obtained in apical 4- and 2-chamber views, each divided into 6 segments. Tracer uptake and myocardial opacification were visually analyzed for each segment by two pairs of blinded observers and graded as normal, mildly reduced, severely reduced, or absent. In 792 myocardial segments, myocardial opacification by MCE was uninterpretable in 143 (18%) segments and tracer uptake by SPECT was not clearly defined in 92 (12%) segments. Interobserver variability for MCE was good with concordance rates of 83% (kappa=0.72) for rest- and 86% (kappa=0.76) for stress images. Overall concordance between MCE and SPECT was good (83%, kappa=0.63) at a segmental level. In the diagnosis of fixed and reversible defects, and of normal perfusion, concordance rates were 73, 65 and 83%, respectively. When analysis was performed at the regional level, we found comparable levels of concordance rates for LAD (83%, kappa=0.59), LCX (86%, kappa=0.64) and RCA (80%, kappa=0.68) perfusion territories. These findings suggest that realtime MCE is a clinically acceptable method to evaluate myocardial perfusion defects during dipyridamole stress testing.
  Zeitschrift für Kardiologie 12/2004; 93(11):890-6. · 0.97 Impact Factor
• Article: Real-time myocardial contrast echocardiography for the detection of stress-induced myocardial ischemia

  A.-E. Dubart, K. G. Carvalho da Silva, G. Korosoglou, R. Bekeredjian, A. Hansen, S. Hardt, M. Rosenberg, N. Ferrari, B. Hoerig, J. Zehelein, H. Kuecherer
  [show abstract] [hide abstract]
  ABSTRACT: Background Real-time contrast echocardiography (MCE) is a new promising technique for assessing myocardial perfusion. The purpose of this study was to test whether realtime MCE can be used to detect functionally significant coronary artery stenosis in patients with known or suspected coronary artery disease. Myocardial contrast echocardiographic studies were compared with nearly simultaneous 99mTc-sestamibi single photon emission computed tomography (SPECT) as a clinical standard reference to evaluate regional myocardial perfusion defects. Methods Real-time MCE based on continuous infusion of Optison (8–10 ml/h) was performed in 66 patients during standard 99mTc-SPECT dipyridamole (0.56 mg/kg4 min) stress testing. Images were obtained in apical 4- and 2-chamber views, each divided into 6 segments. Tracer uptake and myocardial opacification were visually analyzed for each segment by two pairs of blinded observers and graded as normal, mildly reduced, severely reduced, or absent. In 792 myocardial segments, myocardial opacification by MCE was uninterpretable in 143 (18%) segments and tracer uptake by SPECT was not clearly defined in 92 (12%) segments. Interobserver variability for MCE was good with concordance rates of 83% (=0.72) for rest- and 86% (=0.76) for stress images. Overall concordance between MCE and SPECT was good (83%, =0.63) at a segmental level. In the diagnosis of fixed and reversible defects, and of normal perfusion, concordance rates were 73, 65 and 83%, respectively. When analysis was performed at the regional level, we found comparable levels of concordance rates for LAD (83%, =0.59), LCX (86%, =0.64) and RCA (80%, =0.68) perfusion territories. Conclusions These findings suggest that realtime MCE is a clinically acceptable method to evaluate myocardial perfusion defects during dipyridamole stress testing.Die Echtzeitkontrastechokardiographie (MCE) ist ein neues Verfahren zur Beurteilung der Myokardperfusion. Ziel der Studie war es zu testen, ob mittels Echtzeit MCE funktionell signifikante Koronarstenosen bei Patienten mit vermuteter oder bekannter koronarer Herzerkrankung erkannt werden knnen. Kontrastechokardiographische Untersuchungen wurden mit nahezu simultan durchgefhrten 99mTc-sestamibi SPECT-Untersuchungen verglichen. Die SPECT-Szintigraphie diente als klinischer Goldstandard zum Nachweis regionaler myokardialer Perfusionsdefekte. Echtzeit-Kontrastechokardiographische Untersuchungen wurden unter Verwendung einer kontinuierlichen Infusion von Optison (8–10 ml/h) durchgefhrt. Eingeschlossen wurden 70 konsekutive Patienten, bei denen aus klinischer Indikation eine pharmakologische Stressuntersuchung (99mTc-SPECT, Dipyridamol 0,56 mg/kg4 Minuten) durchgefhrt wurde. Apikale Vier- und Zweikammerblicke wurden in jeweils 6 Segmente unterteilt. Traceranreicherung und Myokardkontrastierung wurden von zwei unabhngigen Untersuchern visuell beurteilt (als normal, gering reduziert, stark reduziert oder fehlend). Die Myokardkontrastierung konnte in 143 von 792 Wandsegemten (18%) nicht adquat analysiert werden. Die Traceranreicherung war in 92 Segmenten (12%) nicht adquat analysierbar. Die Untersucherbereinstimmung war akzeptabel (Konkordanzraten 83% (=0,72) fr Ruhe- und 86% (=0,76) fr stressechokardiographische Untersuchungen). Die bereinstimmung zwischen MCE und SPECT-Befunden auf segmentaler Ebene war gut (83%, =0,63). Gute bereinstimmungen wurden auch bei der Erfassung fixer und reversibler Perfusionsdefekte und normal perfundierter Segmente gefunden (65, 73 und 83%). Bei der Auswertung einzelner Koronarversorgungsgebiete lagen fr alle drei Territorien gute bereinstimmungen vor (LAD, 83%, =0,59; LCX, 86%, =0,64 und RCA, 80%, =0,68). Diese Daten zeigen, dass sich die Echtzeitkontrastechokardiographie zur Erfassung von Perfusionsdefekten eignet.
  Zeitschrift für Kardiologie 10/2004; 93(11):890-896. · 0.97 Impact Factor