Important parameters in the detection of left main trunk disease using stress myocardial perfusion imaging

Shiba, Chie; Chikamori, Taishiro; Hida, Satoshi; Igarashi, Yuko; Tanaka, Hirokazu; Hirose, Katsumi; Ohtaki, Yuka; Usui, Yasuhiro; Miyagi, Manabu; Hatano, Tsuguhisa; Yamashina, Akira

doi:10.1016/j.jjcc.2008.08.010

Cited by 20 publications

(15 citation statements)

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“…found significant correlation between IVUS assessed plaque burden and FFR in cases of ambiguous left main stenosis [11]. Inducible ischemia, detected either during stress perfusion scintigraphy [14,15] or stress echocardiography [16] is also an important factor in the determination of the physiologic severity of LM disease. Coronary flow reserve, assessed by transthoracic Doppler echocardiography has been also extensively studied and proposed as a valuable adjunct in ambiguous cases following coronary angiography [18].…”

Section: Discussionmentioning

confidence: 99%

“…Although it provides detailed anatomical information on the vessel lumen, it is an expensive and invasive procedure. Several other diagnostic tools, such as myocardial perfusion scintigraphy [14,15], stress echocardiography [16], multidetector computed tomography [17] and coronary flow reserve measurement [18,19] have been proposed as valuable adjunct to coronary angiography in the difficult clinical decision making process of patients with borderline LM lesions. It has also been demonstrated, that simple resting Doppler transthoracic echocardiography (TTDE) is an effective method in assessing hemodynamically significant LM lesions [20-22].…”

Section: Introductionmentioning

confidence: 99%

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Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study

Ruzsa

Pálinkás

Forster

et al. 2011

Cardiovasc Ultrasound

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Backgroundthe clinical decision making could be difficult in patients with borderline lesions (visually assessed stenosis severity of 30 to 50%) of the left main coronary artery (LM). The aim of the study was to evaluate the relationship between transthoracic Doppler (TTDE) peak diastolic flow velocity (PDV) and intravascular ultrasound (IVUS) measurements in the assessment of angiographically borderline LM lesions.Methods27 patients (mean age 64 ± 8 years, 21 males) with borderline LM stenosis referred for IVUS examination were included in the study. We performed standard IVUS with minimal lumen area (MLA) and plaque burden (PB) measurement and routine quantitative coronary angiography (QCA) with diameter stenosis (%DS) and area stenosis (%AS) assessment in all. During TTDE, resting PDV was measured in the LM.Resultsinterpretable Doppler signal could be obtained in 24 patients (88% feasibility); therefore these patients entered the final analysis. MLA was 7.1 ± 2.7 mm2. TTDE measured PDV correlated significantly with IVUS-derived MLA (r = -0.46, p < 0.05) and plaque burden (r = 0.51, p < 0.05). Using a velocity cut-off of 112 cm/sec TTDE showed a 92% sensitivity and 62% specificity to identify IVUS-significant (MLA < 6 mm2) LM stenosis.ConclusionIn angiographically borderline LM disease, resting PDV from transthoracic echocardiography is increased in presence of increased plaque burden by IVUS. TTDE evaluation might be a useful adjunct to other invasive and non-invasive methods in the assessment of borderline LM lesions. Further, large scale studies are needed to establish the exact cut-off value of PDV for routine clinical application.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study

Ruzsa

Pálinkás

Forster

et al. 2011

Cardiovasc Ultrasound

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“…Therefore, even if stress MPI was used to examine myocardial ischemia in patients with LMTD, ischemia would have been missed in 88%. 3 Recently, FFR analysis using pressure wire has been widely recognized and used in the clinical field of interventional cardiology. 4,5 FFR analysis can evaluate the hemodynamic significance of each diseased vessel without the influence of balance ischemia, but it requires an invasive procedure and drug stress test.…”

Section: Images In Cardiovascular Medicinementioning

confidence: 99%

Clinical Utility of Fractional Flow Reserve on Computed Tomography in Left Main Trunk Disease

Okonogi

Kawasaki

2018

Circ J

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normal left ventricular wall motion, while CCTA using a 320-row CT (Aquillion ONE, Toshiba Medical Systems, Ohtawara, Japan) showed severe stenosis in the distal left main trunk (LMT) bifurcation (Figure 1). In this case, adenosine 201 Tl-myocardial perfusion imaging (MPI) showed no apparent perfusion defects in the left coronary area on MPI/CT fusion image (Figure 1) with summed stress score 2, summed rest score 0, and no transient ischemic dilatation. The washout rate of the present patient for adenosine 201 Tl-myocardial perfusion image was 44.68% which was slightly lower than the normal washout rate of the present institution ( Figure S1). This indicated no myocardial ischemia. On FFRCT analysis, however, FFR of the H emodynamic assessment of coronary artery disease (CAD) is important for performing appropriate percutaneous coronary intervention (PCI). Fractional flow reserve on computed tomography (FFRCT) is a new technology provided by HeartFlow. This is an epoch-making analytical method that allows the data from standard coronary computed tomography angiography (CCTA) to yield hemodynamic assessment of CAD without invasive procedures. 1A 58-year-old woman with risk factors of type 2 diabetes mellitus and dyslipidemia developed chest discomfort on mild effort. Electrocardiography showed complete right bundle block, and ultrasound cardiography showed a IMAGES IN CARDIOVASCULAR MEDICINEAdvance Publication by-J-STAGE

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“…A FFR value between 0.75 and 0.80 is deemed to be in the gray zone. MPI has limitation in identification of the highest risk subsets, left main coronary artery disease and three-vessel coronary artery disease, because of "balanced ischemia" [93][94][95][96][97][98] . One study showed that in patients with left main coronary artery disease, MPI results were normal in 5% and lowrisk in 10% of patients [93] .…”

Section: Future Perspectivementioning

confidence: 99%

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Iwasaki¹

2014

WJC

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Previous studies demonstrated that coronary revascularization, especially percutaneous coronary intervention (PCI), does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease. Many studies using myocardial perfusion imaging (MPI) showed that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit, whereas for patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality. There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia, which is associated with increased mortality. Studies using fractional flow reserve (FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI, and the presence of ischemia is the key to decisionmaking for PCI. Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method's limitations. Recent studies of appropriateness criteria showed that, although PCI in the acute setting and coronary bypass surgery are properly performed in most patients, PCI in the non-acute setting is often inappropriate, and stress testing to identify myocardial ischemia is performed in less than half of patients. Also, some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis. Taken together, the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease, and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Coronary artery bypass surgery; Coronary revascularization; Fractional flow reserve; Myocardial ischemia; Myocardial perfusion imaging; Percutaneous coronary intervention Core tip: Studies of myocardial perfusion imaging demonstrate that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit. For patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality probably because of worsened ischemia. Studies using fractional flow reserve demonstrate that ischemia-guided percutaneous coronary intervention (PCI) is superior to angiography-guided PCI, and the presence of ischemia is the key factor in decision-making for PCI. Thus, myocardial ischemia is a key factor in the management of patients with stable coronary artery disease.Iwasaki K. Myocardial ischemia is a key factor in the management of stable coronary artery disease. World J Cardiol

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Important parameters in the detection of left main trunk disease using stress myocardial perfusion imaging

Abstract: In the identification of LMT disease, lung uptake of radiotracers was a single best parameter, which was independent of the presence or absence of previous MI.

Cited by 20 publications

References 39 publications

Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study

Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study

Clinical Utility of Fractional Flow Reserve on Computed Tomography in Left Main Trunk Disease

Myocardial ischemia is a key factor in the management of stable coronary artery disease

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