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Published on: April 13, 2015
Correlation of Non-Invasive Transthoracic Doppler Echocardiography with Invasive Doppler Wire-Derived Coronary Flow
Dejan Milasinovic1,2, Milorad Tesic1,2, Olga Nedeljkovic Arsenovic2,3
1Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Insights
Coronary microvascular dysfunction after myocardial infarction impacts prognosis. Invasive and non-invasive coronary flow reserve (CFR) measurements show similar predictive ability for infarct size in STEMI patients, especially in the LAD artery.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Coronary microvascular dysfunction is linked to poor outcomes post-ST-elevation myocardial infarction (STEMI).
- Accurate assessment of coronary flow reserve (CFR) is crucial for predicting prognosis.
- Comparing invasive and non-invasive CFR methods is important for clinical application.
Purpose of the Study:
- To compare invasive Doppler wire-based CFR with non-invasive transthoracic Doppler echocardiography (TTDE)-derived CFR.
- To evaluate the predictive ability of both CFR methods for final infarct size after STEMI.
Main Methods:
- 36 STEMI patients undergoing primary PCI had invasive Doppler wire CFR assessed.
- TTDE-derived CFR was measured in 47 vessels (29 patients) within 6 hours of invasive assessment.
- Infarct size was quantified using cardiac magnetic resonance (CMR) at 8 months.
Main Results:
- A modest correlation was observed between invasive and TTDE-derived CFR overall (rho=0.400, p=0.005).
- Correlation improved significantly for LAD artery measurements (rho=0.554, p=0.002) but not RCA.
- Both invasive and TTDE-derived CFR effectively predicted large infarct size (≥18% LV mass) with AUCs of 0.888 and 0.868, respectively.
Conclusions:
- TTDE-derived CFR shows significant correlation with invasive Doppler wire CFR in the LAD artery post-STEMI.
- Both invasive and non-invasive CFR methods demonstrate comparable strong associations with final infarct size.
- These findings support the potential utility of non-invasive TTDE for assessing microvascular function and predicting infarct size in STEMI.
Abstract:
Background: Coronary microvascular dysfunction is associated with adverse prognosis after ST-segment elevation myocardial infarction (STEMI). We aimed to compare the invasive, Doppler wire-based coronary flow reserve (CFR) with the non-invasive transthoracic Doppler echocardiography (TTDE)-derived CFR, and their ability to predict infarct size. Methods: We included 36 patients with invasive Doppler wire assessment on days 3-7 after STEMI treated with primary percutaneous coronary intervention (PCI), of which TTDE-derived CFR was measured in 47 vessels (29 patients) within 6 h of the invasive Doppler. Infarct size was assessed by cardiac magnetic resonance at a median of 8 months. Results: The correlation between invasive and non-invasive CFR was modest in the overall cohort (rho 0.400, p = 0.005). It improved when only measurements in the LAD artery were considered (rho 0.554, p = 0.002), with no significant correlation in the RCA artery (rho -0.190, p = 0.435). Both invasive (AUC 0.888) and non-invasive (AUC 0.868) CFR, measured in the recanalized culprit artery, showed a good ability to predict infarct sizes ≥18% of the left ventricular mass, with the optimal cut off values of 1.85 and 1.80, respectively. Conclusions: In patients with STEMI, TTDE- and Doppler wire-derived CFR exhibit significant correlation, when measured in the LAD artery, and both have a similarly strong association with the final infarct size.
