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[Noninvasive assessment of left internal thoracic artery graft patency using transthoracic echocardiography]
1Division of Cardiovascular Surgery, Akita Medical Center, Japan.
Insights
Transthoracic echocardiography (TTE) effectively assesses left internal thoracic artery (LITA) graft patency after coronary artery bypass grafting (CABG). TTE demonstrated high specificity for diagnosing LITA graft patency, aiding in differentiating graft stenosis.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Surgery
Background:
- Long-term patency of left internal thoracic artery (LITA) grafts is crucial for coronary artery bypass grafting (CABG) outcomes.
- Assessing LITA graft patency non-invasively remains a clinical challenge.
Purpose of the Study:
- To evaluate the diagnostic utility of transthoracic echocardiography (TTE) for assessing long-term left internal thoracic artery (LITA) graft patency following coronary artery bypass grafting (CABG).
Main Methods:
- Simultaneous assessment of graft flow velocity using TTE and graft angiography in 36 patients post-CABG.
- TTE visualization of LITA graft flow velocity from the left supraclavicular echo view.
- Calculation of flow velocity ratios (D/S, D/(S+D)) to assess graft patency and stenosis.
Main Results:
- TTE visualized LITA graft flow in 25 patients, achieving 71.4% sensitivity and 100% specificity for graft patency compared to angiography.
- Significantly higher peak flow velocity and time velocity integral ratios were observed in patients without graft stenosis (APS(-)) compared to those with stenosis (APS(+)) or old myocardial infarction (OMI).
- TTE successfully differentiated between patent grafts and those with stenosis based on flow velocity parameters.
Conclusions:
- Transthoracic echocardiography is a valuable non-invasive tool for assessing long-term left internal thoracic artery graft patency after CABG.
- TTE's high specificity allows for reliable differentiation of graft stenosis, aiding clinical decision-making.
- Echocardiographic assessment of LITA graft flow velocity can provide important insights into graft function and patient prognosis.
Abstract:
To evaluate the utility of transthoracic echocardiography (TTE) for assessing the long-term patency of left internal thoracic artery (LITA) grafts, 36 patients who had coronary artery bypass grafting (CABG) were examined simultaneously for graft flow velocity by TTE and by graft angiogram. The flow velocity in the LITA graft was clearly visualized by TTE in 25 patients from the left supraclavicular echo view. On the basis of the angiogram, the sensitivity and specificity of TTE in the diagnosis of LITA graft patency were 71.4% and 100%, respectively. These 25 patients (mean follow-up time after CABG-29.6 months) were divided into 3 groups according to their preoperative diagnosis and the presence of grafts stenosis by angiogram as follows: APS(-), angina pectoris without graft stenosis in 15 cases; APS(+), angina pectoris with graft stenosis in 2 cases; OMI, old myocardial infarction without graft stenosis in 8 cases. The peak flow velocity D/S ratio and time velocity integral D/S ratio in the APS(-) group (2.48 +/- 0.73, 3.21 +/- 0.89) were significantly (p < 0.01) higher than those in the APS(+) group (0.30 +/- 0.23, 0.35 +/- 0.21) or in the OMI group (0.96 +/- 0.44, 0.87 +/- 0.51). Peak flow velocity D/(S+D) and time velocity integral D/(S+D) ratios in the APS(-) group (0.70 +/- 0.05, 0.75 +/- 0.06) were significantly (p < 0.01) higher than those in the APS(+) group (0.22 +/- 0.14, 0.25 +/- 0.11) or in the OMI group (0.46 +/- 0.17, 0.43 +/- 0.18).(ABSTRACT TRUNCATED AT 250 WORDS)