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Published on: August 28, 2018

Transthoracic echocardiography in the detection of chronic total coronary artery occlusion

Alla A Boshchenko1, Alexander V Vrublevsky, Rostislav S Karpov

  • 1Department of Atherosclerosis and Coronary Artery Disease, Cardiology Research Institute, Russian Academy of Medical Sciences, Siberian Branch, Kievskaya Street, 111a, 634012 Tomsk, Russia. cobra@mail.tomsknet.ru

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology
|May 21, 2008
PubMed

Insights

Transthoracic echocardiography (TTE) effectively detects chronic total occlusions in the left anterior descending and right coronary arteries by analyzing collateral blood flow. This non-invasive method shows high sensitivity and specificity for diagnosing these coronary artery occlusions.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Techniques

Background:

  • Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
  • Chronic total occlusions (CTO) in major coronary arteries present diagnostic challenges.
  • Non-invasive imaging modalities are sought to improve CTO detection and patient management.

Purpose of the Study:

  • To evaluate the efficacy of transthoracic echocardiography (TTE) in detecting CTO of the left anterior descending (LAD), circumflex (Cx), and right coronary arteries (RCA).
  • To assess the diagnostic performance of TTE in identifying CTO by analyzing coronary blood flow direction in collateral vessels.

Main Methods:

  • A prospective study involving 110 patients undergoing coronary angiography for angina investigation.
  • Transthoracic echocardiography was used to assess coronary blood flow direction in epicardial and intramyocardial collaterals.
  • Sensitivity and specificity calculations were performed for LAD and RCA CTO detection based on retrograde flow patterns.

Main Results:

  • TTE demonstrated high sensitivity (89%) and specificity (96%) for detecting LAD CTO when assessing both distal LAD and septal branches.
  • For RCA CTO, TTE achieved 89% sensitivity and 97% specificity using both PDA and septal branches.
  • TTE was less successful in visualizing circumflex artery collaterals (31% success rate), limiting its diagnostic utility for Cx occlusions.

Conclusions:

  • Transthoracic echocardiography is a sensitive and highly specific non-invasive tool for diagnosing LAD and RCA CTOs.
  • The detection of coronary blood flow direction in collateral vessels is key to TTE's diagnostic capability for these occlusions.
  • TTE is not recommended for diagnosing Cx occlusions due to visualization limitations.
Abstract

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