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Published on: June 28, 2019
Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison
Antonio Auriti1, Christian Pristipino, Cinzia Cianfrocca
1Department of Cardiovascular Disease-Echocardiography Unit-S, Filippo Neri Hospital, Rome, Italy. a.auriti@sanfilipponeri.roma.it
Insights
Transthoracic echocardiography (TTDE) can reliably assess coronary flow reserve (CFR) in the Left Circumflex artery (LCx). This noninvasive method shows good correlation with the Doppler-wire gold standard, aiding in diagnosing coronary artery disease.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Coronary Artery Disease
Background:
- Assessing coronary flow reserve (CFR) in distal coronary arteries using transthoracic echocardiography (TTDE) is challenging.
- Previous TTDE validation studies focused on LAD and PD arteries, but not the technically difficult LCx artery.
Purpose of the Study:
- To evaluate the reliability of TTDE for assessing LCx CFR compared to the intracoronary Doppler-wire (DW) gold standard.
Main Methods:
- Five patients underwent both TTDE and invasive CFR assessment for the LCx artery on separate, randomized days.
- TTDE used a low-frequency probe with a four-chamber view; adenosine was the vasodilator stimulus for both methods.
Main Results:
- LCx CFR values by DW ranged from 1.9-2.8, and by TTDE from 2.0-3.0, showing strong correlation (R=0.85, p=0.06).
- Both techniques concordantly identified normal (CFR > 2.5) or abnormal (CFR < 2.5) LCx CFR in 80% of cases.
Conclusions:
- Transthoracic echocardiography is a viable noninvasive method for obtaining LCx CFR.
- TTDE offers a reliable alternative to invasive methods for LCx CFR assessment.
Background:
Coronary flow reserve (CFR) recording by means of transthoracic echocardiography (TTDE) in all the main distal coronary arteries is a challenge for advanced echocardiography. Validation studies of TTDE versus Doppler-wire (DW) recordings are available for Left Anterior Descending artery (LAD) and the Posterior Descending coronary artery (PD), but lacking for the more technically challenging Left Circumflex coronary artery (LCx).
Aim:
To evaluate the reliability of TTDE in assessing CFR in LCx when compared to the intracoronary Doppler flow-wire gold standard.
Methods:
we evaluated 5 patients (age = 60 +/- 9 years, 5 males) on LCx by TTDE and invasive CFR assessment. TTDE recording was performed using a low-frequency probe, with a four-chamber as a guiding 2D view. The 2 tests were performed on different days and in random order within 48 hours in a blind fashion. Vasodilator stimulus was adenosine, intravenously (140 gamma/kg/min x 3-6 min) for TTDE and intracoronary (40 gamma bolus) for DW recordings.
Results:
CFR values on LCx ranged from 1.9 to 2.8 for DW, and from 2.0 to 3.0 for TTDE, with an overall correlation of R = 0,85 (p = 0,06); normal (CFR > 2.5) or abnormal (CFR < 2.5) value was concordantly identified by the 2 techniques in 4 out 5 cases (80%).
Conclusion:
CFR of LCx artery can be obtained noninvasively with TTDE.
