Simple detection of severe coronary stenosis using transthoracic Doppler echocardiography at rest
S Higashiue1, H Watanabe, Y Yokoi
1Division of Cardiovascular Surgery, Kishiwada Tokusyukai Hospital, Kishiwada, Japan.
Insights
Transthoracic Doppler echocardiography (TTDE) can measure coronary flow velocity. This study shows that the diastolic-to-systolic flow velocity ratio (DSVR) measured by TTDE at rest effectively detects severe coronary stenosis.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Coronary artery disease (CAD) diagnosis relies on invasive methods.
- Noninvasive techniques for assessing coronary stenosis are crucial for early detection and management.
- Transthoracic Doppler echocardiography (TTDE) offers a noninvasive approach to evaluate coronary blood flow.
Purpose of the Study:
- To evaluate the efficacy of the diastolic-to-systolic flow velocity ratio (DSVR) measured by TTDE at rest in detecting severe coronary stenosis.
- To assess the correlation between DSVR values and the severity of coronary artery stenosis.
Main Methods:
- Prospective study of 190 patients with angina pectoris scheduled for coronary angiography.
- Measurement of Doppler spectral tracings of flow velocity in the distal left anterior descending artery using TTDE at rest.
- Calculation of mean and peak diastolic-to-systolic flow velocity ratios (DSVR).
- Comparison of DSVR values in patients with and without severe coronary stenosis (>85% diameter stenosis).
Main Results:
- Successful DSVR measurement by TTDE was achieved in 83.7% of patients.
- Significantly lower DSVR values were observed in patients with severe coronary stenosis compared to those without (p <0.0001).
- In patients with successful intervention, DSVR significantly increased post-procedure (p <0.0001).
- Optimal cut-off points for severe stenosis were identified as 1.6 for peak DSVR and 1.5 for mean DSVR, with good sensitivity and specificity.
Conclusions:
- DSVR measurement by TTDE at rest is a simple and noninvasive method for detecting severe coronary stenosis.
- TTDE-derived DSVR can serve as a valuable tool in the noninvasive assessment of coronary artery disease.
- This technique may help stratify patients and guide further diagnostic or therapeutic decisions.
Abstract:
Coronary flow velocity can be measured by transthoracic Doppler echocardiography (TTDE). The purpose of this study was to detect severe coronary stenosis using the diastolic-to-systolic flow velocity ratio (DSVR) determined by TTDE at rest. We prospectively examined 190 consecutive patients with angina pectoris for whom coronary angiography was planned. Doppler spectral tracings of flow velocity in the distal left anterior descending artery were recorded by TTDE at rest. The mean and peak DSVR values were computed using mean and peak coronary flow velocities. DSVR measurement by TTDE at rest was performed within 24 hours before angiography, and in patients who underwent coronary intervention it was performed again within 48 hours after the intervention. The success rate for DSVR measurement by TTDE was 83.7%. There were significant differences in peak DSVR and mean DSVR between the patients with severe stenosis (percent diameter stenosis >85%) and those without severe stenosis (1.3 +/- 0.4 vs 1.9 +/- 0.50 and 1.2 +/- 0.4 vs 1.8 +/- 0.5, respectively; p <0.0001). In the 17 patients with successful intervention, DSVR was significantly increased after the procedure (mean 1.2 +/- 0.1 vs 2.0 +/- 0.2; peak 1.2 +/- 0.2 vs 2.0 +/- 0.3, respectively; p <0.0001). For percent diameter stenosis >85%, the best cut-off points were 1.6 for peak DSVR (sensitivity 79.0%, specificity 75.7%) and 1.5 for mean DSVR (sensitivity 77.0%, specificity 77.9%). Thus, DSVR measurement by TTDE is a simple, noninvasive method for detection of severe coronary stenosis at rest.
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