Related Experiment Video
Updated: Aug 11, 2026
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Does Doppler echography have a diagnostic role in patency assessment of internal thoracic artery grafts?
Catherine M Jones1, Thanos Athanasiou, Paris P Tekkis
1Academic Surgical Unit, Department of Cardiothoracic Surgery, Imperial College of Science Technology and Medicine, St Mary's Hospital, London W2 1NY, UK.
Insights
Transthoracic Doppler echocardiography (TDE) effectively assesses internal thoracic artery graft patency after coronary artery bypass grafting (CABG), showing high accuracy, especially in patients with postoperative angina. TDE is a valuable non-invasive tool for initial graft assessment.
Area of Science:
- Cardiovascular Imaging
- Surgical Assessment
- Diagnostic Accuracy Studies
Background:
- Substantial literature exists comparing coronary angiography and transthoracic Doppler echocardiography (TDE) for internal thoracic artery (ITA) graft patency post-coronary artery bypass grafting (CABG).
- Conflicting reports on TDE's diagnostic accuracy have hindered its routine use for graft patency assessment.
- A comprehensive review and meta-analysis are needed to clarify TDE's role.
Purpose of the Study:
- To review the available literature on the diagnostic accuracy of TDE for assessing coronary bypass graft patency.
- To perform a meta-analysis of diagnostic accuracy data from relevant studies.
- To identify factors influencing TDE performance and optimal diagnostic criteria.
Main Methods:
- A systematic literature search identified relevant studies comparing TDE with coronary angiography for ITA graft patency.
- Meta-analysis was conducted, calculating pooled sensitivity, specificity, and diagnostic odds ratio.
- Summary receiver operating characteristic (SROC) curve analysis and meta-regression were performed to assess accuracy against study quality and other variables.
Main Results:
- Twenty studies involving 929 patients were analyzed, with grafts visualized in 90% of cases.
- Pooled sensitivity was 85% and specificity was 94%, with a high diagnostic odds ratio of 100.7 (SROC area under curve: 0.96).
- Diastolic fraction < 0.5 demonstrated the best performance (sensitivity 89%, specificity 94%) for predicting stenosis; performance was lower with peak diastolic to systolic velocity ratio < 1.
Conclusions:
- Transthoracic Doppler echocardiography is an effective first-line tool for assessing left internal thoracic artery graft patency after CABG, offering high specificity.
- TDE can prevent invasive investigations and shows improved performance in patients experiencing postoperative angina.
- Due to visualization limitations, TDE is best utilized in conjunction with other non-invasive tests for comprehensive postoperative coronary bypass patient assessment.
Abstract:
The amount of literature published over the past decade comparing coronary angiography with transthoracic Doppler echocardiography assessment of internal thoracic artery graft patency after CABG is substantial. There has been no review of the available literature, and conflicting reports of diagnostic accuracy have prevented routine use of transthoracic Doppler in graft patency assessment. Thus, this article reviews the available literature on diagnostic accuracy of transthoracic Doppler echocardiography of coronary bypass grafts. Relevant studies were identified and meta-analysis of diagnostic accuracy was performed. Study quality was assessed. Quantitative data synthesis included calculation of sensitivity, specificity, summary receiver operating characteristic curve analysis, pooled analysis and meta-regression of accuracy against study quality, publication date, angina, probe frequency and diagnostic criteria. Twenty studies of 929 patients produced 26 results included for analysis. Grafts were not visualized in 93 (10%) patients. Pooled sensitivity (85%) and specificity (94%) and diagnostic odds ratio (100.7) were high. SROC analysis showed an area under the curve of 0.96. Heterogeneity of results was due to variations in diagnostic criteria and study size. Subgroup analysis showed best performance in patients with postoperative angina (p = 0.014). Study quality did not affect results. Diastolic fraction less than 0.5 (sensitivity 89%, specificity 94%) was shown to be the best criterion for prediction of stenosis. Performance was lower using peak diastolic to systolic velocity ratio less than 1 (sensitivity 85%, specificity 86%). Transthoracic Doppler echography is effective in first-line assessment of left internal thoracic artery graft patency. It shows high specificity, prevents invasive investigations and improves in patients with postoperative angina. TDE is best used in combination with other non-invasive tests due to its inability to visualize the graft. The potential for use in postoperative coronary bypass patients is high.
More Related Videos
Related Concept Videos
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation