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Transthoracic echocardiographic detection of coronary atherosclerosis
O Petrovic1, G B Elsner, R L Wilensky
1Indiana University School of Medicine, Indianapolis, Indiana, USA.
Insights
Transthoracic echocardiography can detect coronary atherosclerosis by identifying thickened coronary artery walls. This ultrasound technique shows promise for non-invasively diagnosing coronary artery disease (CAD).
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Ultrasound
Background:
- Coronary atherosclerosis involves coronary artery wall thickening, potentially impairing blood flow.
- Accurate detection of coronary atherosclerosis is crucial for managing cardiovascular disease.
- Current diagnostic methods may be invasive or have limitations.
Purpose of the Study:
- To evaluate the utility of transthoracic echocardiography in detecting coronary atherosclerosis.
- To assess the ability of ultrasound to identify thickened coronary artery walls.
- To determine if echocardiography can qualitatively identify coronary atherosclerosis.
Main Methods:
- Eighty-nine patients undergoing coronary angiography were examined using a 3-5 MHz broadband ultrasonic transducer.
- A modified short-axis view targeted the left main and proximal left anterior descending arteries.
- Echograms were analyzed qualitatively (brightness, uniformity, persistence) and quantitatively (artery wall thickness).
Main Results:
- Segmental wall changes were observed in 52/56 patients with obstructive coronary artery disease (CAD).
- A coronary artery wall thickness >= 1.5 mm was found in 46/56 patients with obstructive CAD.
- Ultrasonic findings demonstrated varying sensitivity and specificity in predicting the presence or absence of coronary atherosclerosis.
Conclusions:
- Transthoracic echocardiography can identify coronary atherosclerosis through qualitative assessment of coronary artery walls.
- Ultrasonic evaluation of the proximal left coronary artery shows potential as a valuable clinical tool.
- This non-invasive method may aid in the diagnosis of coronary atherosclerosis.
Abstract:
Coronary atherosclerosis is a pathologic process that produces thickening of the walls of the coronary arteries to the point that flow through those vessels may be impaired. This study attempts to use transthoracic echocardiography to detect coronary atherosclerosis. Eighty-nine patients undergoing coronary angiography were examined with a broad-band ultrasonic transducer with a frequency between 3 and 5 MHz. A modified short axis examination was utilized to identify left main and proximal left anterior descending arteries. The examination was recorded digitally and displayed in a 32-cell, quad screen cine loop. Fifty-six of the 89 patients (63%) had obstructive coronary artery disease (CAD) (i.e, at least 1 vessel with 50% obstruction). There were 14 patients with CAD but no vessel had > or = 50% obstruction. Nineteen patients (21%) had angiographically normal arteries. The coronary echograms were judged qualitatively for brightness, uniformity, and persistence (defined as the ability to see segments of the artery walls in more frames than other segments). The length of the coronary artery visualized, the width of the left main coronary artery, and the width of the thickest segment of the coronary artery walls were quantitatively measured. More than 2 cm of the left coronary artery was seen in almost all patients. Segmental changes were noted in 52 of the 56 patients with obstructive CAD, 12 of the 14 patients with nonobstructive CAD, and 3 of the 19 patients with normal arteries. Persistence greatly enhanced the ability to judge the segmental changes. Forty-six patients with obstructive disease had wall thickness > or = 1.5 mm. Only 6 patients with nonobstructive coronary arteries had this wall thickness, and only 1 normal subject had thick walls. The ultrasonic findings were useful in predicting the presence or absence of coronary atherosclerosis to varying degrees of sensitivity and specificity based on the segmental findings and wall thickness measurements. The results of this study indicate that a transthoracic ultrasonic examination of the proximal left coronary artery could be a clinically valuable tool in the qualitative identification of coronary atherosclerosis.