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Relation between Duke treadmill score and coronary flow reserve using transesophageal Doppler echocardiography in
Ho-Joong Youn1, Chul-Soo Park, Keon-Woong Moon
1Division of Cardiology, Department of Internal Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62 Yoido-dong, Youngdungpo-Ku, Seoul 150-713, South Korea. younhj@catholic.ac.kr
Insights
The Duke treadmill score (DTS) reflects coronary flow reserve (CFR) in patients with microvascular angina. A higher DTS indicates better CFR, aiding in assessing ischemia severity.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Exercise Physiology
Background:
- Microvascular angina diagnosis can be challenging.
- Coronary flow reserve (CFR) assesses myocardial perfusion.
- The Duke treadmill score (DTS) is a common stress test metric.
Purpose of the Study:
- To investigate the relationship between CFR and DTS in patients with microvascular angina.
- To determine if DTS can predict CFR and ischemia severity.
Main Methods:
- 108 patients with chest pain and normal coronary angiograms were studied.
- Exercise treadmill testing (ETT) was performed using the Bruce protocol to calculate DTS.
- Coronary flow velocity was measured using transesophageal Doppler echocardiography (TEE) to calculate CFR.
Main Results:
- CFR was significantly lower in patients with a positive ETT compared to those with a negative ETT (2.19 vs. 3.04, P<0.001).
- CFR varied significantly across DTS risk groups: high risk (<= -11) had CFR of 1.51, moderate risk (-11 to +5) had CFR of 2.39, and low risk (>= +5) had CFR of 3.04 (P<0.001).
- DTS showed a strong positive correlation with CFR (r=0.704, P<0.001).
Conclusions:
- DTS is a valuable composite index that correlates with CFR in patients with microvascular angina.
- DTS can assist clinicians in evaluating the severity of myocardial ischemia.
- This study establishes DTS as a useful, non-invasive tool for assessing microvascular dysfunction.
Objectives:
The link between coronary flow reserve (CFR) and Duke treadmill score (DTS) in patients with microvascular angina remains elusive.
Methods:
We studied 108 subjects (M/F=48:60, mean age 54+/-9 years) with chest pain and normal coronary angiogram. ETT was performed by Bruce's protocol and the equation for calculating DTS was DTS=exercise duration-(5x ST deviation)-(4x exercise angina), with 0=none, 1=nonlimiting, 2=exercise limiting. The coronary flow velocity at diastole (PDV) using transesophageal Doppler echocardiography (TEE) was obtained from the proximal left anterior descending coronary artery and CFR was calculated as the ratio of hyperemic PDV after the intravenous infusion of dipyridamole (0.56 mg/kg) to baseline PDV.
Results:
CFR was 3.04+/-0.45 in group with negative ETT and 2.19+/-0.62 in group with positive ETT (P<0.001) and was 1.51+/-0.31 in high risk group with a score of < or = -11, 2.39+/-0.63 in moderate risk group with scores between -11 and + 5, and 3.04+/-0.43 in low risk group with a score of > or = +5 on DTS (P<0.001 versus low risk group, respectively). DTS has significant correlation with CFR (r=0.704, P<0.001).
Conclusions:
DTS is a composite index that reflects CFR and helps clinicians determine the severity of ischemia in patients with microvascular angina.
