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Sanjeev Bhattacharyya, Roxy Senior, The current state of myocardial contrast echocardiography: what can we read between the lines? Reply, European Heart Journal - Cardiovascular Imaging, Volume 15, Issue 3, March 2014, Pages 351–352, https://doi.org/10.1093/ehjci/jet249
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We thank Gibson et al.1 for their interest in our article. The authors have raised important issues. We agree that the uptake of myocardial contrast echocardiography (MCE) for stress echocardiography within the UK has been low.2 This may be surprising given the wealth of data that has accumulated over the past decade, demonstrating the clinical, prognostic, and practical value of performing MCE stress echocardiography using exercise, dobutamine, and dipyridamole techniques.
There have been multiple large prospective and multicentre studies, which have demonstrated that MCE stress echocardiography is safe and comparable with single-photon emission computed tomography (SPECT) for the detection of coronary artery disease3,4 with consistent superior sensitivity in the intermediate high-risk population. Furthermore, assessment of myocardial perfusion with MCE stress echocardiography has advantages compared with analysis of wall motion alone. The addition of MCE perfusion imaging during stress echocardiography performed with either dobutamine or exercise or high-dose dipyridamole improved the sensitivity for the detection of coronary artery disease over wall motion analysis alone and provided incremental prognostic information.5,6,7 Indeed, a large randomized trial clearly established both diagnostic and prognostic advantages of myocardial perfusion with MCE over optimal wall motion assessment.8,9
