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Relation between changes in coronary flow velocity and in wall motion for assessing contractile reserve during
Masaaki Takeuchi1, Hidetoshi Yoshitani, Chinami Miyazaki
1Department of Internal Medicine, Tane General Hospital, Sakaigawa, Nishi-ku, Osaka, Japan. masaaki_takeuchi@hotmail.com
Insights
Transthoracic Doppler echocardiography (TTDE) can assess coronary flow velocity (CFV) and wall motion during dobutamine stress echocardiography (DSE). This study shows CFV changes correlate with myocardial viability in patients with coronary artery disease.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Myocardial Perfusion
Background:
- Resting wall motion abnormalities (WMAs) can indicate coronary artery disease.
- Assessing myocardial viability is crucial for guiding treatment decisions.
- Dobutamine stress echocardiography (DSE) is a common tool for evaluating inducible ischemia.
Purpose of the Study:
- To investigate the relationship between coronary flow velocity (CFV) and regional wall motion during DSE.
- To evaluate the feasibility of using transthoracic Doppler echocardiography (TTDE) to measure CFV in the left anterior descending (LAD) coronary artery territory.
- To determine if CFV changes can predict myocardial functional recovery.
Main Methods:
- 150 patients with resting WMAs in the LAD territory underwent contrast-enhanced DSE.
- CFV was measured in the distal LAD using TTDE during DSE.
- CFV ratio (stress CFV/basal CFV) and regional wall motion were analyzed.
- Patients were grouped based on their response: sustained improvement, biphasic, worsening, or no change.
Main Results:
- CFV was successfully recorded in 86% of patients.
- Basal CFV did not differ significantly among the groups.
- CFV ratio at peak stress was significantly higher in patients with sustained improvement compared to other groups.
- CFV ratio showed a strong correlation with functional recovery, distinguishing between different response patterns.
Conclusions:
- Simultaneous assessment of CFV and wall motion during DSE is feasible.
- CFV measured by TTDE provides valuable information on myocardial viability.
- CFV assessment complements conventional echocardiographic evaluation of myocardial perfusion and function.
Abstract:
The purpose of this study was to determine the relationship between coronary flow velocity (CFV) measured by transthoracic Doppler echocardiography (TTDE) and wall motion during dobutamine stress echocardiography (DSE) in patients with resting wall motion abnormalities (WMAs). One hundred fifty patients with resting WMA in the left anterior descending coronary artery (LAD) territory underwent CFV recording in the distal LAD by TTDE during contrast-enhanced DSE. Regional wall motion, CFV, and CFV ratio, defined as a ratio of CFV at each stage of dobutamine stress to basal CFV, were obtained. Patients were divided into 4 groups (sustained improvement, biphasic response, worsening response, and no change). CFV was successfully recorded in 129 patients during DSE (86%). The mean value of basal CFV did not differ among the 4 groups. Although CFV ratio during DSE progressively increased in patients with sustained improvement, this increase was blunted with biphasic response and almost lost with worsening or no change response (P <.001, ANOVA). CFV ratio at peak stress was significantly higher in patients with sustained improvement (2.73 +/- 0.69) than that with the other 3 groups (P <.001). The value with biphasic response (1.68 +/- 0.56) was also higher than that with worsening (0.98 +/- 0.15, P <.005) and no change (1.28 +/- 0.38, P <.08). The simultaneous assessment of CFV and function in the LAD territory is feasible, and flow and function are closely correlated. TTDE provides flow information that may complement conventional echocardiographic assessment of myocardial viability.
