Doppler determined aortic acceleration after dipyridamole in the prediction of coronary artery disease
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S Dubrey1, T Y Huehns, S Parker
1Department of Academic Medicine, Charing Cross and Westminster Medical School, London, UK.
Insights
Changes in aortic blood flow acceleration during stress tests do not reliably detect coronary artery disease. This method showed poor specificity and high variability, limiting its clinical use for diagnosing myocardial ischemia.
Area of Science:
- Cardiology
- Medical Imaging
- Hemodynamics
Background:
- Myocardial ischemia detection often relies on stress testing.
- Aortic blood flow acceleration changes are proposed indicators of ischemia.
- Clinical utility requires validation against established diagnostic methods.
Purpose of the Study:
- To evaluate the clinical usefulness of aortic blood flow acceleration changes.
- To compare this method with dipyridamole thallium scintigraphy and coronary angiography.
- To assess its diagnostic accuracy for coronary artery disease (CAD).
Main Methods:
- 101 patients studied, 64 underwent coronary angiography.
- Dipyridamole stress was used to measure maximum aortic acceleration.
- Comparison with thallium scintigraphy and coronary angiography findings.
Main Results:
- Maximum aortic acceleration increased significantly after dipyridamole.
- No correlation found between aortic acceleration and thallium perfusion defects.
- Sensitivity for CAD was 92%, but specificity was only 37%.
- Results remained inconclusive even after excluding patients with prior cardiac events.
Conclusions:
- Aortic blood flow acceleration changes after dipyridamole do not predict CAD presence or severity.
- High variability limits its routine clinical application for myocardial ischemia.
- This method is not a reliable diagnostic tool for coronary artery disease.
Abstract:
Change in the acceleration of aortic blood flow with stress testing is reported to reflect the presence of myocardial ischaemia. We studied its clinical usefulness when compared with dipyridamole thallium scintigraphy in 101 patients, of whom 64 had coronary angiography. Maximum aortic acceleration increased after dipyridamole (P < 0.0001), although no correlation existed between the aortic acceleration and evidence of thallium perfusion abnormalities. For the patients who had angiography, the increase in aortic acceleration was similar for those with no significant coronary stenoses, single vessel or multi-vessel disease. Compared with coronary angiography, Doppler measurement of maximum aortic acceleration had a sensitivity of 92% and a specificity of 37% for the detection of coronary artery disease. When patients with previous myocardial infarction or left ventricular dysfunction were excluded, there was still no relationship between the maximum aortic acceleration and the presence of coronary artery disease. We conclude that changes in the acceleration of aortic blood flow after dipyridamole stressing do not predict the presence or severity of coronary artery disease as measured from perfusion defects at thallium scintigraphy or by coronary angiography. We have observed a wide variability of aortic maximum acceleration in the evaluation of myocardial ischaemia, which we feel introduces serious limitations to its use in routine clinical practice.