Noninvasive detection of total occlusion of the left anterior descending coronary artery with transthoracic Doppler echocardiography

Watanabe, Nozomi; Akasaka, Takashi; Yamaura, Yasuko; Akiyama, Maki; Koyama, Yuji; Kamiyama, Norio; Neishi, Yoji; Kaji, Shuichiro; Saito, Yasuhiro; Yoshida, Kiyoshi

doi:10.1016/s0735-1097(01)01556-x

Cited by 56 publications

(34 citation statements)

References 21 publications

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“…Nevertheless, the TDE finding of retrograde diastolic flow, either in the epicardial vessel or in perforating branches, is a useful and specific sign of coronary occlusion. The reasons for the discrepancy between our data and those of others 9,10 are not clear, but patient selection, racial difference in chest wall acoustic impedance, and coronary flow sampling site by TDE may play a role. In our population, there was also some discrepancy between the direction of flow when detected at angiography or by TDE.…”

Section: Discussioncontrasting

confidence: 99%

“…A possible explanation may be that Werner et al 12 included patients with previous myocardial infarctions of the index artery, whereas Watanabe et al 9 and we studied only patients without previous infarctions of the myocardium distal to the occluded artery. In addition, there may be some pitfalls in the measurement of collateral flow by intracoronary Doppler flow wire: (1) it is technically demanding, (2) the position of the tip of the wire relative to the occlusion and to the input of collateral flow may be suboptimal, (3) sampling too close to the occlusion site may result in small coronary flow velocity recordings, (4) artifacts may be generated by guidewire motion and inadvertent contact with the vessel wall, 13 and (5) placing the Doppler wire requires a previous opening of the vessel with a stiff wire, which creates a new channel, potentially altering collateral flow dynamics.…”

Section: Discussionmentioning

confidence: 91%

“…9 Similarly, flow direction in perforating branches was defined as normal (anterograde) or inverted (retrograde). 10 Coronary flow velocity was measured by pulsed Doppler ultrasound under color-coding guide.…”

Section: Methodsmentioning

confidence: 99%

“…6 -8 TDE can also predict left anterior descending (LAD) coronary occlusion on the basis of reversed flow in the epicardial artery 9 and in its perforating branches. 10 We undertook this study to (1) assess the feasibility of TDE to noninvasively measure coronary flow reserve of the collateral-dependent circulation distal to the occluding lesion and (2) determine the relation of collateral flow reserve (CFR) to the angiographic collateral anatomy and flow.…”

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confidence: 99%

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Functional Assessment of the Collateral-Dependent Circulation in Chronic Total Coronary Occlusion Using Transthoracic Doppler Ultrasound and Venous Adenosine Infusion

Pizzuto¹,

Voci²,

Puddu³

et al. 2006

The American Journal of Cardiology

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The measurement of collateral flow reserve (CFR; the hyperemic/baseline collateral flow velocity ratio) in patients with chronic total coronary occlusion requires invasive and expensive techniques. Noninvasive transthoracic coronary Doppler echocardiography may be an alternative option. Fifty-one patients with chronic total coronary occlusion were evaluated by transthoracic coronary Doppler echocardiography and venous adenosine infusion to measure CFR in occluded coronary arteries (the left anterior descending artery in 44 patients and the artery supplying the posterior descending artery in 7 patients). CFR data were plotted against 3 angiographic parameters: (1) grade of the epicardial filling of the occluded artery (1 ‫؍‬ absent, 2 ‫؍‬ partial, 3 ‫؍‬ complete), (2) stenosis of the donor artery, and ( Recently, transthoracic coronary Doppler echocardiography (TDE) has been introduced and validated for the noninvasive prediction of coronary artery disease, 1-4 the assessment of coronary recanalization in acute myocardial infarction, 5 and the evaluation of therapeutic coronary interventions. 6 -8 TDE can also predict left anterior descending (LAD) coronary occlusion on the basis of reversed flow in the epicardial artery 9 and in its perforating branches. 10 We undertook this study to (1) assess the feasibility of TDE to noninvasively measure coronary flow reserve of the collateral-dependent circulation distal to the occluding lesion and (2) determine the relation of collateral flow reserve (CFR) to the angiographic collateral anatomy and flow. MethodsStudy population: We enrolled 56 consecutive patients (46 men, 10 women, mean age 59 Ϯ 9 years, range 43 to 75) with chronic total occlusion of the LAD (44 patients) and of the artery supplying the posterior descending coronary artery (PD; 12 patients). Inclusion criteria were (1) Thrombolysis In Myocardial Infarction anterograde coronary flow grade 0, (2) normal global and regional left ventricular function at rest (wall motion score index ϭ 1), and (3) the absence of Q-wave myocardial infarction. Patients with contraindications to adenosine administration were excluded. All patients were in sinus rhythm and fasting state and provided written informed consent. All coronary active medications were withdrawn the day before the Doppler study. Figure 1 shows the clinical model that we used: occluded coronary artery (either the LAD or the artery supplying the PD), visible collaterals toward the occluded artery, and good left ventricular function.TDE: TDE was performed as previously described in a modified 2-chamber view, 4,6 using Sequoia C256 and C512 ultrasound systems (Siemens-Acuson, Mountain View, California). The LAD was scanned by a dedicated 7-MHz transducer (3.5 MHz in color Doppler ultrasound) along the anterior interventricular groove, 6 and the PD was scanned using a standard 3.5-MHz transducer (2 MHz in color Doppler ultrasound). 4 The best long-axis view in color Doppler imaging was obtained to optimize the angle be-

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Functional Assessment of the Collateral-Dependent Circulation in Chronic Total Coronary Occlusion Using Transthoracic Doppler Ultrasound and Venous Adenosine Infusion

Pizzuto¹,

Voci²,

Puddu³

et al. 2006

The American Journal of Cardiology

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“…However, it has been reported that total LAD occlusion can be detected on TTE. 58) These reports have shown that the sensitivity and specificity of TTE in identifying LAD occlusion are almost 100%. 58)59) However, it is very difficult to apply this TTE technique to the LCX or RCA.…”

Section: Evaluation Of Coronary Atherosclerosismentioning

confidence: 98%

Transesophageal Echocardiographic Evaluation of Atherosclerosis

Nishino

Tanouchi

2008

Korean Circ J

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Transesophageal echocardiography (TEE) is a promising method for evaluating thoracic aortic atherosclerosis and coronary atherosclerosis. The highest impact of TEE as a clinical tool is in searching for cardiac embolic sources in patients with stroke and atrial fibrillation and in conducting detailed evaluations in patients with valvular disease, especially those with mitral valvular disease. However, it is also clinically useful in the evaluation of thoracic aortic atherosclerosis and coronary atherosclerosis. TEE is capable of evaluating thoracic aortic atherosis (intima-media complex thickness) and sclerosis (stiffness parameter β) simultaneously. In addition, TEE can evaluate coronary atherosclerosis by non-invasively revealing narrowing or occlusion of the coronary arteries and providing information about coronary flow reserve. TEE imaging has improved with the advent of harmonic imaging, multiplane probes, contrast agents, and three-dimensional TEE. Future technology, including integrated backscatter (IBS), tissue Doppler, and strain imaging, will lead to further improvements in TEE. Thoracic aortic atherosclerosis and coronary atherosclerosis assessment should be performed in any patient undergoing TEE.

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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 detection of total occlusion of the left anterior descending coronary artery with transthoracic Doppler echocardiography

Abstract: Retrograde flow in the LAD by TTDE is a highly sensitive and specific finding that can be used to noninvasively diagnose total LAD occlusion.

Cited by 56 publications

References 21 publications

Functional Assessment of the Collateral-Dependent Circulation in Chronic Total Coronary Occlusion Using Transthoracic Doppler Ultrasound and Venous Adenosine Infusion

Functional Assessment of the Collateral-Dependent Circulation in Chronic Total Coronary Occlusion Using Transthoracic Doppler Ultrasound and Venous Adenosine Infusion

Transesophageal Echocardiographic Evaluation of Atherosclerosis

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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