Noninvasive assessment of coronary flow velocity reserve in left anterior descending artery adds diagnostic value to both clinical variables and dobutamine echocardiography: a study based on clinical practice

Florenciano-Sánchez, Rafael; Morena, Gonzalo de la; Villegas-García, Manuel; Soria-Arcos, Federico; Rubio-Patón, Ramón; Teruel-Carrillo, F.; Hurtado, José Antonio; Valdés‐Chávarri, Mariano

doi:10.1016/j.euje.2004.10.007

Cited by 12 publications

(3 citation statements)

References 33 publications

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“…Recently, sampling of coronary artery velocities especially of the left anterior descending coronary artery by transthoracic Doppler became feasible [3-7]. Incorporation of analysis of coronary velocities in stress studies adds diagnostic value to both clinical variables and dobutamine echocardiography [8]. Thus, coronary flow reserve of the left anterior descending coronary artery is more sensitive and less specific than analysis of wall motion abnormalities [9], and the diagnostic accuracy of both methods are similar [10].…”

Section: Introductionmentioning

confidence: 99%

Coronary Flow Reserve of the Non-Ischemia Related Coronary Artery During Dobutamine Stress Echocardiography

et al. 2011

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BackgroundIncorporation of analysis of coronary velocities in stress studies adds diagnostic value to both clinical variables and dobutamine echocardiography. Micorcirculatory abnormalities may precede obstructive corornary disease. Therefore the aim of this study was to assess Doppler derived coronary velocity and flow of the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE) in patients without LAD-related ischemia.MethodsSixty nine patients with chest pain underwent DSE studies to evaluate myocardial ischemia. All had trans-thoracic Doppler interrogation of the distal LAD before and just after termination of the DSE. Coronary velocity reserves (CFR) were calculated as the ratios of post-DSE/baseline diastolic velocities. Volumetric flow in the distal LAD was calculated from the diameter of LAD color jet and velocity integral. Volumetric flow reserve was calculated as the ratio of post-DSE baseline LAD flows.ResultsAt rest all subjects had left ventricular wall motion score index (WMSI) = 1, while in 28, wall motion abnormality appeared in non-LAD territory with WMSI = 1.17 ± 0.08. Peak diastolic velocity after DSE increased form 28.5 ± 13.6 to 52.4 ± 23.7 cm/sec, P = 9.5 × 10-11, and velocity-CFR was 2.08 ± 0.7. Diastolic LAD flow increased from 36.5 ± 23.8 to 75.75 ± 48.7 mL/min, P = 1.21 × 10-7 and volumetric-CFR was 2.6 ± 2.8. Peak diastolic velocity-CFR in patients without LV wall motion abnormality was 2.4 ± 0.7 while in those with motion abnormality 1.77 ± 0.56, P = 0.00008. Flow-derived LAD-CFR was 3.3 ± 3.7 in those without compared to 1.88 ± 0.57 in patients with wall motion abnormality, P < 0.05.ConclusionLAD velocity and flow reserves are reduced in patients with remote myocardial ischemia, which may indicate early atherosclerotic involvement.

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Section: Introductionmentioning

confidence: 99%

Coronary Flow Reserve of the Non-Ischemia Related Coronary Artery During Dobutamine Stress Echocardiography

et al. 2011

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“…In another study based on clinical practice, noninvasive assessment of CFR in LAD added diagnostic value to both clinical data and variables derived from DOBSE; sensitivity and specificity of abnormal CFR (< 2) to detect LAD stenosis were 86% and 57%, respectively; wall motion abnormalities had a sensitivity and specificity of 52% and 82%, respectively [39], but the main limitation of this study was that CFR and wall motion analysis were not performed simultaneously.…”

Section: Coronary Flow Reserve During Dobutamine Stress Echocardiographymentioning

confidence: 98%

Assessment of Coronary Flow During Stress Testing: Does it Add Diagnostic and Prognostic Value?

Lowenstein¹,

Tiano

2011

Curr Cardiovasc Imaging Rep

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The aim of this review is to focus on the additional diagnostic and prognostic value of Doppler echocardiographicderived coronary flow reserve over regional wall motion during pharmacological stress echocardiography in different clinical scenarios. Imaging coronary flow dramatically expands the diagnostic and prognostic potential of stress echocardiography and this is probably one of the largest contributions, considering that we are witnessing a more rational and advanced methodology of second-generation stress echocardiography.

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“…CFR has been found to be useful in detecting significant stenosis of LAD in patients with cardiovascular diseases of different origins [5]. To the best of our knowledge, only one study evaluated the diagnostic utility of CFR in detecting LAD stenosis in patients with LBBB in comparison with non-gated SPECT myocardial perfusion imaging with thallium-201 [6].…”

Section: Introductionmentioning

confidence: 99%

Comparative utility of gated myocardial perfusion imaging and transthoracic coronary flow reserve for the assessment of coronary artery disease in patients with left bundle branch block

Pavlović

Šobić-Šaranović

Djordjevic‐Dikic

et al. 2010

Nuclear Medicine Communications

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Our results show comparable diagnostic utility and high agreement between gated SPECT MIBI perfusion imaging and TTDE CFR assessment for detecting CAD in patients with LBBB. The advantage of gated SPECT MIBI over TTDE CFR measurements is the ability to assess the perfusion abnormalities in multiple vascular territories during the same procedure, which is convenient for detecting multi-vessel disease in patients with LBBB.

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Noninvasive assessment of coronary flow velocity reserve in left anterior descending artery adds diagnostic value to both clinical variables and dobutamine echocardiography: a study based on clinical practice

Abstract: An abnormal coronary flow velocity reserve by transthoracic Doppler echocardiography adds diagnostic value to both clinical data and variables derived from dobutamine stress echo to detect significant left anterior descending artery stenosis.

Cited by 12 publications

References 33 publications

Coronary Flow Reserve of the Non-Ischemia Related Coronary Artery During Dobutamine Stress Echocardiography

Coronary Flow Reserve of the Non-Ischemia Related Coronary Artery During Dobutamine Stress Echocardiography

Assessment of Coronary Flow During Stress Testing: Does it Add Diagnostic and Prognostic Value?

Comparative utility of gated myocardial perfusion imaging and transthoracic coronary flow reserve for the assessment of coronary artery disease in patients with left bundle branch block

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