Transthoracic echocardiography for non-invasive assessment of coronary vasodilator function after DES implantation
Ville Varho1, Pasi P Karjalainen2, Antti Ylitalo2
1Heart Centre Turku University Hospital and University of Turku, Hämeentie 9, Turku 20520, Finland.
Insights
Transthoracic echocardiography (TTE) reliably assesses coronary flow reserve (CFR) after drug-eluting stent (DES) implantation, aligning well with invasive methods. This non-invasive technique can identify impaired CFR in patients post-percutaneous coronary intervention.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Microvascular Function
Background:
- Coronary vasodilator dysfunction is a concern after drug-eluting stent (DES) implantation.
- Transthoracic echocardiography (TTE) is suggested for assessing coronary flow reserve (CFR) in stable angina, but its utility in DES patients is unproven.
Purpose of the Study:
- To evaluate the agreement between TTE-derived CFR (CFRTTE) and invasive thermodilution-derived CFR (CFRThermodilution).
- To assess the association of these CFR measures with the index of microcirculatory resistance (IMR).
- To determine the reliability of TTE for CFR assessment in patients with DES mid-term after percutaneous coronary intervention for acute coronary syndrome.
Main Methods:
- Assessed CFRTTE and CFRThermodilution 3 months post-DES implantation in the LAD artery of 24 patients.
- Excluded patients with significant epicardial stenosis (FFR <0.75).
- Correlated CFRTTE with CFRThermodilution and assessed their relationship with IMR using Bland-Altman analysis.
Main Results:
- Good correlation found between CFRTTE and CFRThermodilution (r = 0.71, P < 0.001).
- CFRThermodilution values were generally higher than CFRTTE.
- TTE successfully discriminated moderately and severely impaired CFR compared to invasive methods.
- No association was detected between CFR measurements and IMR.
Conclusions:
- TTE is a feasible and reliable method for assessing CFR and vasodilator dysfunction after DES implantation.
- TTE-derived CFR values accurately identify abnormalities confirmed by invasive thermodilution.
- The findings support TTE's role in evaluating microvascular and epicardial vasodilator function post-DES.
Aims:
Coronary vasodilator dysfunction has been reported after drug-eluting stent (DES) implantation. Recent ESC guidelines suggest that transthoracic echocardiography (TTE) may be considered for assessment of coronary flow reserve (CFR) and microvascular disease in patients with stable angina, but its reliability has not been tested in patients with DES. We sought to assess the agreement between TTE (CFRTTE) and invasive thermodilution-derived CFR (CFRThermodilution) as well as their association with index of microcirculatory resistance (IMR) in mid-term follow-up after percutaneous coronary intervention for acute coronary syndrome.
Methods And Results:
CFRTTE and CFRThermodilution were assessed 3 months after DES implantation in the left anterior descending artery in 24 patients. Patients with haemodynamically significant epicardial stenosis (fractional flow reserve <0.75) were excluded. Correlation between the two methods was good (r = 0.71, P < 0.001), but CFRThermodilution (mean ± SD) tended to be higher (3.17 ± 1.00 vs. 2.87 ± 0.72; mean difference 0.29, 95% confidence interval -0.06 to 0.59). In Bland-Altman analysis, there was a trend towards a greater difference in the range of higher invasive values. Nevertheless, TTE was successful in discriminating moderately impaired CFR (≤2.5) (P = 0.001) and severely impaired CFR (≤2.0) (P < 0.001) when compared with an invasive method. No association between either CFR measurements vs. IMR measurement was detected, suggesting that in addition to microcirculatory function, CFR also accounts for epicardial vasodilator function in the absence of haemodynamically significant stenosis.
Conclusion:
TTE is a feasible and reliable method for the assessment of CFR and vasodilator dysfunction after DES implantation. Values obtained with this method successfully find abnormal CFR confirmed with the invasive thermodilution method.
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