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Updated: Mar 11, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary
Marie Mide Michelsen1, Naja Dam Mygind2, Adam Pena3
1Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Insights
Transthoracic Doppler echocardiography coronary flow velocity reserve (TTDE CFVR) is repeatable but shows modest agreement with positron emission tomography myocardial blood flow reserve (PET MBFR) in women with angina.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Physiology
Background:
- Coronary microvascular dysfunction is assessed noninvasively by transthoracic Doppler echocardiography coronary flow velocity reserve (TTDE CFVR) and positron emission tomography myocardial blood flow reserve (PET MBFR).
- PET MBFR is the reference standard but has limited availability.
- TTDE CFVR is a potential alternative for assessing coronary microvascular function.
Purpose of the Study:
- To compare TTDE CFVR with PET MBFR in women with angina and non-obstructive coronary artery disease.
- To assess the repeatability of TTDE CFVR in this patient group.
Main Methods:
- 107 women with angina and non-obstructive coronary artery disease underwent both TTDE CFVR (dipyridamole stress) and PET MBFR (adenosine stress).
- Repeatability of TTDE CFVR was assessed in 10 symptomatic women and 10 healthy individuals.
Main Results:
- Median MBFR (2.68) was systematically higher than CFVR (2.31).
- Pearson's correlation coefficient was 0.36 (p<0.01), indicating modest agreement.
- TTDE CFVR demonstrated good repeatability in both symptomatic women (0.48) and healthy individuals (0.44).
Conclusions:
- TTDE CFVR is a repeatable measure of coronary microvascular function.
- The agreement between TTDE CFVR and PET MBFR is modest, potentially due to methodological differences (flow velocity vs. blood flow).
Background:
Coronary microvascular function can be assessed by transthoracic Doppler echocardiography as a coronary flow velocity reserve (TTDE CFVR) and by positron emission tomography as a myocardial blood flow reserve (PET MBFR). PET MBFR is regarded the noninvasive reference standard for measuring coronary microvascular function but has limited availability. We compared TTDE CFVR with PET MBFR in women with angina pectoris and no obstructive coronary artery disease and assessed repeatability of TTDE CFVR.
Methods:
From a cohort of women with angina and no obstructive coronary artery stenosis at invasive coronary angiography, TTDE CFVR by dipyridamole induced stress and MBFR by rubidium-82 PET with adenosine was successfully measured in 107 subjects. Repeatability of TTDE CFVR was assessed in 10 symptomatic women and in 10 healthy individuals.
Results:
MBFR was systematically higher than CFVR. Median MBFR (interquartile range, IQR) was 2.68 (2.29-3.10) and CFVR (IQR) was 2.31 (1.89-2.72). Pearson's correlation coefficient was 0.36 (p<0.01). Limits of agreement (2·standard deviation) assessed by the Bland-Altman (confidence interval, CI) method was 1.49 (1.29;1.69) and unaffected by time-interval between examinations. Results were similar when adjusting for rate pressure product or focusing on perfusion of the left anterior descending artery region. Limits of agreement (CI) for repeated CFVR in 10 healthy individuals and in 10 women with angina was 0.44 (0.21;0.68) and 0.48 (0.22; 0.74), respectively.
Conclusion:
CFVR had a good repeatability, but the agreement between CFVR and MBFR was modest. Divergence could be due to methodology differences; TTDE estimates flow velocities whereas PET estimates myocardial blood flow.
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