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Coronary Doppler intensity changes during handgrip: a new method to detect coronary vasomotor tone in coronary artery
1Institute of Cardiac Surgery, University of Rome La Sapienza, Italy. voci@uniromal.it
Insights
Quantitative Doppler intensity during handgrip effectively detects coronary artery disease (CAD) and vasomotor dysfunction. This non-invasive method offers high sensitivity and specificity for identifying coronary vasomotor dysfunction in CAD patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Physiology
Background:
- Coronary artery disease (CAD) is associated with exaggerated vasoconstriction during handgrip.
- Doppler signal intensity, reflecting blood cell flow, is expected to decrease during vasoconstriction.
- Measuring Doppler intensity may offer an alternative to velocity measurements for assessing coronary flow changes.
Purpose of the Study:
- To evaluate if quantitative Doppler intensity during handgrip can identify coronary vasomotor dysfunction in patients with CAD.
- To compare Doppler intensity changes during handgrip in patients with and without CAD.
Main Methods:
- Transthoracic color Doppler echocardiography was used to image the left anterior descending coronary artery (LAD) in 47 patients (15 normal, 32 with CAD).
- Doppler signal intensity and velocity parameters were measured at baseline, during 30-s handgrip, and during recovery.
- Analysis focused on mean gray level intensity (IU) in diastole.
Main Results:
- Coronary artery flow velocity parameters showed no significant changes during handgrip in either group.
- Doppler intensity significantly decreased during handgrip in CAD patients (p < 0.001) but increased or remained unchanged in normal subjects.
- Doppler intensity demonstrated high diagnostic accuracy for CAD (sensitivity 84.4%, specificity 93.3%).
Conclusions:
- Quantitative Doppler intensity measurement during handgrip is a viable method for detecting CAD.
- This technique can identify coronary vasomotor dysfunction, a key aspect of CAD pathophysiology.
Objectives:
This study evaluates whether a quantitative measurement of Doppler intensity during handgrip may disclose coronary vasomotor dysfunction in patients with coronary artery disease (CAD).
Background:
Atherosclerotic coronary segments show an exaggerated constrictive response to handgrip. The intensity of the scattered Doppler signal is proportional to the number of blood cells flowing through the vessel, and should be reduced during vasoconstriction. Therefore, changes in coronary flow during handgrip may be detected by measuring Doppler intensity rather than velocities.
Methods:
The distal left anterior descending coronary artery (LAD) was imaged by high-resolution transthoracic color Doppler echocardiography during handgrip in 47 patients: 15 with normal coronary arteries and 32 with significant CAD involving the LAD. The Doppler signal was acquired at 70 dB dynamic range at baseline, 30-s handgrip and 5 min recovery. Peak and mean flow velocity, pressure half-time, deceleration time (ms), deceleration rate (cm/s2) and mean gray level intensity (intensity units [IU]) of the Doppler spectrum were measured in diastole. RESULTS The velocity parameters did not change significantly during handgrip both in normal and CAD patients. The Doppler intensity significantly decreased during handgrip (from 87.0 +/- 32.8 to 57.7 +/- 35.3 IU; p < 0.001) in patients with CAD, and it increased or remained unchanged in normals (from 74.1 +/- 27.3 to 85.1 +/- 31.2 IU; p = NS). The sensitivity of Doppler intensity in detecting CAD was 84.4%, specificity 93.3%, negative predictive value 73.7% and positive predictive value 96.4%.
Conclusions:
Doppler intensity measured by transthoracic echocardiography during handgrip allows the detection of CAD and coronary vasomotor dysfunction.