Noninvasive assessment of myocardial bridging by coronary flow velocity reserve with transthoracic Doppler echocardiography: vasodilator vs. inotropic stimulation

Aleksandric, S; Djordjevic‐Dikic, Ana; Beleslin, Branko; Parapid, Biljana; Teofilovski-Parapid, Gordana; Stepanović, Jelena; Simić, Dragan; Nedeljkovic, I.; Petrović, Milan; Dobrić, Milan; Tomasević, M; Banović, Marko; Nedeljković, Milan; Ostojić, Miodrag

doi:10.1016/j.ijcard.2016.09.101

Cited by 14 publications

(17 citation statements)

References 49 publications

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“…Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography (TTDE) is a clinically useful and feasible noninvasive diagnostic index for the assessment of fixed coronary stenosis severity [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Although adenosine-induced maximal hyperemia is considered a gold standard for TTDE-CFVR measurements in the functional assessment of fixed coronary stenosis, the functional assessment of myocardial bridging (MB) is less reliable [ 9 , 10 , 11 , 12 , 13 , 14 ]. Despite being considered a benign coronary lesion, MB may cause life-threatening events such as ventricular arrhythmias, acute coronary syndrome, or even sudden cardiac death [ 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…As a result of these events, concerns have been raised regarding its clinical significance and the need for appropriate diagnostic test/s which could be helpful in the identification of MB associated with myocardial ischemia [ 14 ]. Therefore, previous studies indicate that the functional assessment of MB should include dobutamine provocation with possibly exaggerated extravascular systolic coronary artery compression [ 9 , 10 , 11 , 12 , 13 , 14 ]. Additionally, the feasibility of assessing CFVR by TTDE during dobutamine provocation is high and the steady-state hyperemia induced with a high-doses of dobutamine (>20 µg/kg/min) is similar to adenosine-induced one [ 13 , 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, previous studies indicate that the functional assessment of MB should include dobutamine provocation with possibly exaggerated extravascular systolic coronary artery compression [ 9 , 10 , 11 , 12 , 13 , 14 ]. Additionally, the feasibility of assessing CFVR by TTDE during dobutamine provocation is high and the steady-state hyperemia induced with a high-doses of dobutamine (>20 µg/kg/min) is similar to adenosine-induced one [ 13 , 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Recently, it has been demonstrated that TTDE-CFVR measured at high-dose dobutamine provides a more accurate functional evaluation of MB compared to adenosine [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the feasibility of assessing CFVR by TTDE during dobutamine provocation is high and the steady-state hyperemia induced with a high-doses of dobutamine (>20 µg/kg/min) is similar to adenosine-induced one [ 13 , 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Recently, it has been demonstrated that TTDE-CFVR measured at high-dose dobutamine provides a more accurate functional evaluation of MB compared to adenosine [ 13 ]. Still, CFVR obtained by TTDE has not been thoroughly evaluated to determine whether it is useful for functional assessment of MB severity.…”

Section: Introductionmentioning

confidence: 99%

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Coronary Flow Velocity Reserve Using Dobutamine Test for Noninvasive Functional Assessment of Myocardial Bridging

Aleksandric

Djordjevic‐Dikic

Tešić

et al. 2021

JCM

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Background: It has been shown that coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) during dobutamine (DOB) provocation provides a more accurate functional evaluation of myocardial bridging (MB) compared to adenosine. However; the cut-off value of CFVR during DOB for identification of MB associated with myocardial ischemia has not been fully clarified. Purpose: This prospective study aimed to determine the cut-off value of TTDE-CFVR during DOB in patients with isolated-MB, as compared with stress-induced wall motion abnormalities (VMA) during exercise stress-echocardiography (SE) as reference. Methods: Eighty-one symptomatic patients (55 males [68%], mean age 56 ± 10 years; range: 27–74 years) with the existence of isolated-MB on the left anterior descending artery (LAD) and systolic MB-compression ≥50% diameter stenosis (DS) were eligible to participate in the study. Each patient underwent treadmill exercise-SE, invasive coronary angiography, and TTDE-CFVR measurements in the distal segment of LAD during DOB infusion (DOB: 10–40 μg/kg/min). Using quantitative coronary angiography, both minimal luminal diameter (MLD) and percent DS at MB-site at end-systole and end-diastole were determined. Results: Stress-induced myocardial ischemia with the occurrence of WMA was found in 23 patients (28%). CFVR during peak DOB was significantly lower in the SE-positive group compared with the SE-negative group (1.94 ± 0.16 vs. 2.78 ± 0.53; p < 0.001). ROC analyses identified the optimal CFVR cut-off value ≤ 2.1 obtained during high-dose dobutamine (>20 µg/kg/min) for the identification of MB associated with stress-induced WMA, with a sensitivity, specificity, positive and negative predictive value of 96%, 95%, 88%, and 98%, respectively (AUC 0.986; 95% CI: 0.967–1.000; p < 0.001). Multivariate logistic regression analysis revealed that MLD and percent DS, both at end-diastole, were the only independent predictors of ischemic CFVR values ≤2.1 (OR: 0.023; 95% CI: 0.001–0.534; p = 0.019; OR: 1.147; 95% CI: 1.042–1.263; p = 0.005; respectively). Conclusions: Noninvasive CFVR during dobutamine provocation appears to be an additional and important noninvasive tool to determine the functional severity of isolated-MB. A transthoracic CFVR cut-off ≤2.1 measured at a high-dobutamine dose may be adequate for detecting myocardial ischemia in patients with isolated-MB.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Coronary Flow Velocity Reserve Using Dobutamine Test for Noninvasive Functional Assessment of Myocardial Bridging

Aleksandric

Djordjevic‐Dikic

Tešić

et al. 2021

JCM

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“…In the last decade, coronary flow velocity reserve (CFVR) assessed with transthoracic Doppler echocardiography in the mid-distal left anterior descending (LAD) coronary artery entered the clinical evaluation, which can provide useful quantitative information on the functional status of coronary artery circulation. 5 It has been proved valuable in the prediction of cardiovascular events and overall mortality in patients with known or suspected coronary artery disease (CAD). 6 An impaired CFVR (< 2.0) was associated with a significant increase in the occurrence of cardiac events.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of coronary flow velocity reserve in patients with homozygous familial hypercholesterolemia

et al. 2021

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Background: Coronary flow velocity reserve (CFVR) can provide useful quantitative information on the functional status of coronary artery circulation, and an impaired CFVR (< 2.0) was associated with a significant increase in the occurrence of cardiac events. Coronary artery disease (CAD) is the leading cause of death in homozygous familial hypercholesterolemia (HoFH), but the relationship between impaired CFVR and outcome in HoFH has never been discussed before Methods: To explore the long-term prognostic value of CFVR in patients with HoFH, 39 HoFH patients with CFVR data (mean age with 16.7 years) were enrolled from the Genetic and Imaging of Familial Hypercholesterolemia in Han Nationality Study. All patients were divided into impaired CFVR (CFVR < 2.0, n = 17) and preserved CFVR (CFVR≥2.0, n = 22) group. Follow-up was performed until a major adverse cardiac event (MACE) occurred or up to June 30, 2020Results: During a median follow-up of 89 months, 16 events were registered, 12 of which were occurred in the impaired CFVR group and four occurred in the preserved CFVR group. The event-free survival rate of impaired CFVR group was significantly lower than that in the preserved CFVR group (29.4% vs 81.8%, P < .001), and CFVR < 2.0 was independently associated with prognosis before and after adjustment for related risk factors (HR 5.197, 95% CI 1.669 to 16.178, P = .004 and HR 5.488, 95% CI 1.470 to 20.496, P = .011, respectively)Conclusions: an impaired CFVR predicts a worse outcome in HoFH. CFVR shows an independent value in the prediction of long-term outcome in HoFH.

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Stress Echocardiography in Special Subsets of Angiographically Defined Patients: Normal Coronary Arteries, Single-Vessel Disease, Left Main, Chronic Total Occlusion, and Patients Undergoing Coronary Revascularization

Beleslin,

Picano

2023

Stress Echocardiography

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Noninvasive assessment of myocardial bridging by coronary flow velocity reserve with transthoracic Doppler echocardiography: vasodilator vs. inotropic stimulation

Cited by 14 publications

References 49 publications

Coronary Flow Velocity Reserve Using Dobutamine Test for Noninvasive Functional Assessment of Myocardial Bridging

Coronary Flow Velocity Reserve Using Dobutamine Test for Noninvasive Functional Assessment of Myocardial Bridging

Prognostic value of coronary flow velocity reserve in patients with homozygous familial hypercholesterolemia

Stress Echocardiography in Special Subsets of Angiographically Defined Patients: Normal Coronary Arteries, Single-Vessel Disease, Left Main, Chronic Total Occlusion, and Patients Undergoing Coronary Revascularization

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