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Noninvasive assessment of coronary flow dynamics before and after coronary angioplasty using transesophageal Doppler
K Isaaz1, J F Bruntz, G Ethevenot
1Adult Echocardiographic Laboratory, University Central Hospital, University of Nancy, France.
Insights
Transesophageal Doppler effectively measures coronary flow velocity changes after angioplasty for left anterior descending artery stenosis. This non-invasive technique accurately assesses procedural success by detecting significant increases in peak diastolic velocity.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Physiology
Background:
- Invasive Doppler studies show improved coronary flow after angioplasty.
- Transesophageal Doppler (TED) allows coronary flow velocity measurement in the left anterior descending (LAD) artery.
Purpose of the Study:
- To determine if TED can detect coronary flow velocity changes in LAD stenosis patients undergoing angioplasty.
- To evaluate TED's non-invasive capability in assessing angioplasty outcomes.
Main Methods:
- Twenty-three patients with LAD stenosis underwent TED before and after angioplasty.
- Pulsed Doppler with color flow imaging measured LAD coronary flow velocities.
- Quantitative coronary arteriography assessed stenosis severity.
Main Results:
- Successful LAD angioplasty (16/19 patients) showed a significant increase in peak diastolic velocity (37 to 51 cm/s, p=0.0001).
- Unsuccessful angioplasty (3/19 patients) did not show significant velocity changes.
- A strong linear correlation (r=0.85, p=0.0001) existed between increased diastolic velocity and reduced stenosis.
Conclusions:
- Transesophageal Doppler is a viable non-invasive method to evaluate coronary flow dynamics post-angioplasty.
- TED can accurately assess the success of percutaneous transluminal coronary angioplasty for LAD stenosis.
Abstract:
Recent invasive studies using intracoronary Doppler catheters or guide wires reported improved coronary flow dynamics after successful percutaneous transluminal coronary angioplasty. Transesophageal Doppler enables the measurement of coronary flow velocities within the left anterior descending artery. The present study was designed to test: (1) whether transesophageal Doppler may detect coronary flow velocity changes in patients undergoing angioplasty for left anterior descending artery stenosis, and (2) whether this technique may help to evaluate non-invasively the results of the procedure. Twenty-three patients undergoing angioplasty of the left anterior descending artery were studied by transesophageal Doppler before and < or = 24 hours after the interventional procedure. Coronary flow velocities were measured in the proximal part of the left anterior descending artery with the use of pulsed Doppler guided by color flow imaging. The degree of stenosis was measured by computerized quantitative coronary arteriography. Coronary flow velocity signals were successfully obtained in 19 of 23 patients (83%). In 16 successful angioplasty procedures, peak diastolic velocity increased from 37 +/- 14 cm/s before angioplasty to 51 +/- 16 cm/s after (p = 0.0001). In the 3 patients in whom angioplasty was unsuccessful, transesophageal Doppler showed no significant increase in peak diastolic coronary flow velocity. In a total of 19 angioplasty procedures, a good linear relation was found between the percent changes in coronary flow diastolic velocity and the reduction in the degree of stenosis (r = 0.85; p = 0.0001). All patients with > 20% increase in peak diastolic velocity had > 40% stenosis reduction.(ABSTRACT TRUNCATED AT 250 WORDS)