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Noninvasive assessment of microvascular function in arterial hypertension by transthoracic Doppler harmonic
Thomas Bartel1, Ya Yang, Silvana Müller
1Cardiology Division, Department of Internal Medicine, University of Essen, Essen, Germany. tomas.bartel@uni-essen.de
Insights
Transthoracic Doppler harmonic echocardiography (TTDHE) noninvasively assesses coronary microvascular dysfunction. This echocardiographic method correlates well with invasive measurements, offering a new tool for evaluating coronary flow dynamics.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Coronary flow velocity reserve (CFVR) by TTDHE assesses epicardial stenoses.
- Detecting microvascular disease using TTDHE remains unclear.
Purpose of the Study:
- Investigate transthoracic Doppler harmonic echocardiography (TTDHE) for evaluating coronary flow dynamics.
- Assess microvascular dysfunction noninvasively.
Main Methods:
- Compared TTDHE with intracoronary Doppler (ICD) in 54 patients with chest pain.
- Measured coronary flow velocity reserve (CFVR) at baseline and hyperemia using adenosine.
- Studied hypertensive patients (n=25) versus normotensive controls (n=26).
Main Results:
- TTDHE-derived CFVR closely correlated with ICD measurements (r=0.87, p<0.001).
- CFVR was significantly lower in hypertensive patients (2.44) than normotensive controls (3.33).
- Three patients were excluded due to side effects or poor image quality.
Conclusions:
- TTDHE is suitable for noninvasive assessment of microvascular dysfunction.
- The echocardiographic method shows good agreement with invasive measurements.
- TTDHE provides a valuable tool for evaluating coronary microvascular function.
Objectives:
The present study sought to investigate the use of transthoracic Doppler harmonic echocardiography (TTDHE) to evaluate changes in coronary flow dynamics due to microvascular dysfunction.
Background:
Coronary flow velocity reserve (CFVR) measurements by TTDHE are useful for assessing epicardial coronary artery stenoses. It remains unclear, however, if microvascular disease can be detected.
Methods:
In 54 patients with chest pain, intracoronary Doppler (ICD) and TTDHE were used to measure average peak velocity at baseline and hyperemia. Significant coronary lesions had been ruled out by both angiography and intravascular ultrasound. Comparative measurements were performed in the distal left anterior descending coronary artery after intracoronary and intravenous administration of adenosine, and CFVR was calculated. Hypertensive patients (n = 25) were studied and compared to a control group (26 normotensive individuals).
Results:
Three patients (5%) had to be excluded because of insufficient image quality or side effects. In both groups, TTDHE-derived CFVR data correlated closely with ICD measurements (group 1: y = 0.67x + 0.076, standard error of estimate [SEE] = 0.25, r = 0.87, p < 0.001; group 2: y = 0.64x + 1.11, SEE = 0.26, r = 0.87, p < 0.001). CFVR was lower in hypertensives than in normotensive controls (2.44 +/- 0.49 vs. 3.33 +/- 0.40, p < 0.001, cut point = 2.84).
Conclusions:
The newly described echocardiographic method is suitable for assessing microvascular dysfunction noninvasively and corresponds well to invasive measurements.
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