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New noninvasive method for coronary flow reserve assessment: contrast-enhanced transthoracic second harmonic echo
C Caiati1, C Montaldo, N Zedda
1Institute of Cardiology, University of Cagliari, Cagliari, Italy. carlo.caiati@teseo.it
Insights
This study shows that contrast-enhanced transthoracic echocardiography can noninvasively assess coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD). This method accurately detects significant LAD stenosis.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Assessing coronary flow reserve (CFR) noninvasively is crucial for diagnosing coronary artery disease.
- Transthoracic echocardiography (TTE) with contrast enhancement and harmonic Doppler offers a potential noninvasive method.
- Previous methods for CFR assessment were often invasive.
Purpose of the Study:
- To evaluate the feasibility of using second harmonic echo Doppler with contrast enhancement (Levovist) for noninvasive CFR assessment in the left anterior descending coronary artery (LAD).
- To determine the accuracy of this technique in detecting significant LAD stenosis compared to coronary angiography.
Main Methods:
- Fifty-six patients underwent transthoracic contrast-enhanced pulsed-wave Doppler of the LAD at rest and after dipyridamole-induced vasodilation.
- Harmonic color Doppler was used as a guide for signal acquisition.
- Coronary angiography and intracoronary Doppler flow wire measurements served as comparison standards.
Main Results:
- Contrast enhancement significantly improved the success rate of LAD signal recording.
- Mean CFR was 1.54 in patients with significant LAD stenosis and 2.79 in those without (P<0.001).
- Sensitivity and specificity for detecting significant LAD stenosis were 86% and 90%, respectively, with good agreement with intracoronary measurements.
Conclusions:
- Contrast-enhanced transthoracic echo Doppler using the harmonic mode is a feasible and promising noninvasive technique for CFR assessment.
- This approach offers a valuable tool for evaluating coronary artery stenosis without invasive procedures.
Background:
We tested the hypothesis that blood flow velocity could be recorded in the left anterior descending coronary artery (LAD) during transthoracic echocardiography by use of second harmonic echo Doppler modality along with contrast enhancement (intravenous Levovist) at rest and after pharmacologically induced maximal vasodilation to assess coronary flow reserve (CFR) with a totally noninvasive approach.
Methods And Results:
Fifty-six consecutive patients undergoing coronary angiography underwent transthoracic contrast-enhanced pulsed-wave Doppler recording of blood flow velocity in the LAD by use of harmonic color Doppler as a guide at rest and after maximal vasodilation by dipyridamole infusion. Contrast enhancement with the harmonic mode greatly improved the success rate of recording adequate pulsed-wave Doppler signal in the LAD. CFR was (mean+/-SD) 1.54+/-0.7 in patients with (group 1) and 2. 79+/-0.9 in patients without (group 2) significant LAD stenosis (lumen narrowing >70%) (P<0.001); sensitivity and specificity in detecting significant LAD stenosis were 86% and 90%, respectively. There was close agreement between CFRs determined by this new method and intracoronary Doppler flow wire.
Conclusions:
Contrast-enhanced transthoracic echo Doppler with the harmonic mode is a feasible and promising technique for assessing CFR in a totally noninvasive way.