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Published on: April 13, 2015
Noninvasive assessment of coronary flow reserve with transthoracic signal-enhanced Doppler echocardiography
H Lambertz1, H P Tries, T Stein
1Department of Cardiology, Federal Republic of Germany.
Insights
Noninvasive assessment of coronary flow reserve (CFR) in the left anterior descending artery (LAD) is feasible using transthoracic color Doppler (TTCD) and echo enhancers. This method can help evaluate coronary artery disease severity.
Area of Science:
- Cardiovascular Imaging
- Noninvasive Cardiology
- Echocardiography
Background:
- Coronary flow reserve (CFR) assessment is crucial for managing coronary artery disease (CAD) and predicting prognosis.
- Traditionally, CFR is measured invasively during cardiac catheterization, limiting its widespread use.
- Advancements in high-resolution transthoracic color Doppler (TTCD) enable visualization of distal coronary arteries and noninvasive CFR measurement.
Purpose of the Study:
- To investigate the feasibility of noninvasively assessing CFR in the distal left anterior descending artery (LAD) using echocardiography-enhanced TTCD.
- To compare noninvasive CFR measurements with the degree of coronary diameter stenosis determined by cardiac catheterization.
Main Methods:
- CFR was calculated as the ratio of hyperemic to baseline pulsed wave Doppler time velocity integral during adenosine infusion.
- An echocardiography (echo) enhancer (Levovist) was used when baseline LAD Doppler signals were insufficient.
- Forty-five patients were studied: 15 healthy controls, 15 with 50-85% LAD stenosis, and 15 with >85% LAD stenosis.
Main Results:
- Transthoracic color Doppler (TTCD) successfully visualized LAD flow in 88% of patients.
- CFR was quantifiable in 80% of patients (36/45), with or without echo-enhancing agents.
- Significantly lower CFR values were observed in patients with LAD stenosis compared to controls (P < .01 for 50-85% stenosis, P < .02 for >85% stenosis).
Conclusions:
- Noninvasive CFR assessment in the LAD is feasible in 80% of patients using high-resolution TTCD combined with echo-enhancing agents.
- This technique offers a promising noninvasive alternative for evaluating coronary flow and stenosis severity.
Objectives:
The feasibility of noninvasive assessment of coronary flow reserve (CFR) in the distal left anterior descending artery (LAD) with echocardiography-enhanced transthoracic pulsed wave Doppler guided by high-resolution transthoracic color Doppler (TTCD) was investigated. The results were compared with the degree of coronary diameter stenosis obtained during cardiac catheterization.
Background:
Assessment of CFR has proven to be useful in the selection of patients undergoing invasive treatment of coronary artery disease and in estimating their prognosis. However, CFR could only be determined invasively in everyday practice during catheterization procedures. Recent development of high-resolution TTCD allows transthoracic visualization of distal LAD and supra-apical intramyocardial perforator branches and noninvasive measurement of CFR with pulsed wave Doppler technique.
Methods:
CFR was determined by measuring the ratio of pulsed wave Doppler time velocity integral during adenosine-induced hyperemia (140 microgram/kg/min intravenously) to baseline value. If the baseline Doppler signal of LAD flow was insufficient, an echocardiography (echo) enhancer (Levovist) was used. Forty-five patients were examined by TTCD (7-MHz B-mode, 5-MHz color Doppler, and 3.5-MHz pulsed wave Doppler) after coronary angiography had been performed. Group 1 consisted of 15 patients without heart disease, group 2 of 15 patients with 50% to 85% isolated LAD diameter stenosis, and group 3 of 15 patients with >85% LAD diameter stenosis.
Results:
Peripheral LAD coronary flow at baseline condition was assessed in 40 (88%) patients with TTCD. CFR could be quantified in 36 (80%) of the 45 patients: in 18 patients without echo enhancer, and in 18 patients with echo-enhancing agent. CFR could not be assessed in 9 (20%) patients. CFR in the various groups was as follows: group 1, 3. 13 +/- 0.57; group 2, 2.23 +/- 0.20 (vs group 1: P <.01); and group 3, 1.64 +/- 0.30 (vs group 2: P <.02).
Conclusion:
CFR in the LAD can be determined in 80% of patients with pulsed wave Doppler guided by high-resolution TTCD combined with intravenously administered echo-enhancing agent.
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