CLINICAL INVESTIGATIONS CORONARY ARTERY DISEASE Comparative Diagnostic Accuracy of Multiplane and Multislice Three-Dimensional Dobutamine Stress Echocardiography in the Diagnosis of Coronary Artery Disease Hidetoshi Yoshitani, MD, Masaaki Takeuchi, MD, Victor Mor-Avi, PhD, Yutaka Otsuji, MD, Takeshi Hozumi, MD, and Minoru Yoshiyama, MD, Kitakyushu and Osaka, Japan; Chicago, Illinois Background: Although real-time three-dimensional echocardiography (RT3DE) is useful for delineating the ex- tent and severity of stress-induced wall motion abnormalities during dobutamine stress echocardiography (DSE), it also provides simultaneous multiple two-dimensional cut planes, which may potentially improve the detection of stress-induced wall motion abnormalities. The aim of this study was to determine the compar- ative diagnostic accuracy of RT3DE in multiplane and multislice modes for the diagnosis of coronary artery disease (CAD) during DSE against coronary angiography reference. Methods: Multiplane and multislice cut planes (3 V, GE Healthcare, Milwaukee, WI) at rest and peak dose of dobutamine were acquired in 71 patients with known or suspected CAD. In multiplane mode, matrix array transducer allowed the simultaneous visualization of parasternal long and short-axis views or apical 4-, 2-, and 3-chamber views. From full-volume datasets, 9 equidistant 2-dimensional short-axis images from LV base to apex were extracted and simultaneously displayed (multislice mode). Visual assessment of regional wall motion was performed. Coronary angiography was performed within 48 hours and used as a reference. Results: Abnormal findings (new or worsened wall motion abnormalities or fixed wall motion abnormalities) were noted in 36 patients by multiplane mode and 28 patients by multislice mode. Coronary angiography showed significant stenosis in 32 of 71 patients in 49 of 213 coronary arteries. On a patient basis, sensitivity was not different, but specificity was significantly higher in multislice mode (95%) compared with multiplane mode (77%, P < .05). Diagnostic accuracy for detecting right CAD was also significantly higher in multislice mode (93% vs 80%, P < .05). Conclusion: Assessment of LV wall motion from multiple short-axis slices extracted from full-volume RT3DE datasets improves the diagnosis of CAD and is thus a useful addition to DSE tools. (J Am Soc Echocardiogr 2009;22:437-442.) Keywords: Dobutamine stress echocardiography, Coronary artery disease, Three-dimensional echocardiog- raphy Two-dimensional stress echocardiography is a standard method for detecting the presence and severity of coronary artery disease (CAD). 1-3 However, conventional quad screen display does not en- compass the entire left ventricle (LV), resulting in the potential risk for missing stress-induced wall motion abnormalities. Misalignments of cut plane between rest and peak stress may result in over- or under- estimation of wall motion abnormalities, especially in patients with resting wall motion abnormalities. Real-time three-dimensional echo- cardiography (RT3DE) allows visualization of all LV segments by sim- ply cropping the volumetric three-dimensional (3D) data sets, which has been useful for delineating stress-induced wall motion abnormal- ities during stress echocardiography. 4-7 3D matrix-array transducer is capable of simultaneous real-time two-dimensional (2D) imaging in multiple planes, thus allowing simultaneous display of 2 or 3 planes (multiplane mode). 8,9 Current 3D software also allows simultaneous display of multiple 2D short-axis images from LV base to apex ex- tracted from full-volume datasets (multislice mode). Although previ- ous studies demonstrated the usefulness of multiplane dobutamine stress echocardiography (DSE) for detecting CAD, 8 the superiority From the Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan (H.Y., M.T., Y.O.); Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, Chicago, Illinois (V.M-A.); and Department of Cardiology, Osaka City University, School of Medicine, Osaka, Japan (T.H., M.Y.). Reprint requests: Masaaki Takeuchi, MD, FASE, Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medi- cine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555 Japan (E-mail: masaaki_takeuchi@hotmail.com). 0894-7317/$36.00 Copyright 2009 by the American Society of Echocardiography. doi:10.1016/j.echo.2009.02.005 437