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Acceleration time of systolic coronary flow velocity to diagnose coronary stenosis in patients with microvascular
Kazushi Takemoto1, Kumiko Hirata1, Nozomi Wada1
1Department of Medicine, Wakayama Medical University, Wakayama, Japan.
Insights
Systolic coronary flow velocity acceleration time (%AT) shows promise for diagnosing coronary artery stenosis in patients with microvascular dysfunction. This non-invasive method offers high accuracy, particularly in complex patient groups.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Physiology
Background:
- Microvascular dysfunction complicates the diagnosis of coronary artery stenosis.
- Systolic coronary flow may be less affected by microvascular changes due to myocardial compression.
Purpose of the Study:
- To evaluate the utility of systolic coronary flow velocity acceleration time (%AT) in diagnosing coronary stenosis among patients with microvascular dysfunction.
- To compare the diagnostic performance of %AT with coronary flow velocity reserve (CFVR).
Main Methods:
- Echocardiography assessed coronary flow velocity in 502 patients undergoing coronary angiography.
- Calculated %AT and CFVR during hyperemia induced by adenosine.
- Invasive substudies validated %AT against fractional flow reserve using a dual-sensor guidewire (n=14).
Main Results:
- Patients with coronary stenosis exhibited lower CFVR and higher %AT compared to those without.
- %AT demonstrated good agreement with invasive measurements (r=0.98 for %AT, r=0.74 for fractional flow reserve).
- %AT showed higher sensitivity (83.4%) and comparable accuracy (75.4%) to CFVR (71.1% sensitivity) for detecting stenosis, especially in specific patient subgroups.
Conclusions:
- Percentage acceleration time (%AT) of systolic coronary flow velocity is a valuable, non-invasive marker for diagnosing coronary stenosis.
- %AT is particularly effective in patients with microvascular dysfunction, previous myocardial infarctions, valvular disease, and left ventricular hypertrophy.
Background:
The aim of this study was to test whether acceleration time of systolic coronary flow velocity could contribute to the diagnosis of coronary stenosis in patients with microvascular dysfunction, on the basis of the hypothesis that systolic coronary flow is less influenced by microvascular function because of compressed myocardium.
Methods:
Coronary flow velocity was assessed in the left anterior descending coronary artery during hyperemia with intravenous adenosine by echocardiography in 502 patients who were scheduled for coronary angiography because of coronary artery disease and significant valvular disease. Coronary flow velocity reserve (CFVR) and the percentage acceleration time (%AT), as the percentage of the time from the beginning to the peak of systolic coronary flow over systolic time during hyperemia, were calculated. The diagnostic ability of CFVR and %AT for angiographic coronary artery stenosis was then analyzed. As invasive substudies, fractional flow reserve and %AT by a dual-sensor (pressure and Doppler velocity) guidewire were measured simultaneously with %AT on transthoracic echocardiography (n = 14).
Results:
Patients with coronary stenosis had significantly lower CFVR (1.7 ± 0.4) and greater %AT (65 ± 9%) compared with those without stenosis (2.6 ± 0.6 and 50 ± 13%, respectively). Percentage acceleration time by Doppler echocardiography was in good agreement with %AT (r = 0.98) and fractional flow reserve (r = 0.74) invasively measured by dual-sensor guidewire. Cutoff values of CFVR and %AT were determined as 2.0 and 60% in receiver operating characteristic curve analysis. The sensitivity, specificity, and accuracy of CFVR to detect coronary stenosis were 71.1%, 77.3%, and 75.4%, while those of %AT were 83.4%, 71.8%, and 75.4%, respectively. In addition, %AT provided high accuracy to detect coronary stenosis, especially in patients with previous myocardial infarctions, valvular disease, and left ventricular hypertrophy (81.1%, 84.1%, and 73.4%, respectively).
Conclusions:
The %AT of systolic coronary flow velocity is a promising marker to diagnose coronary stenosis in patients with microvascular dysfunction.
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