The Additive Diagnostic Role of Coronary Flow Reserve in Noninvasive Evaluation of Coronary Stenosis on Left Descending Artery Previously Detected by Multislice Computed Tomography

Mladenović, Zorica; Djordjevic‐Dikic, Ana; Tavciovski, Dragan; Angelkov, Andjelka Ristic; Jović, Zoran; Djuric, Predrag

doi:10.1111/echo.12041

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…We could notice to some extent an inferior concordance of results between the techniques regarding the RCA, due to its worse visualization because of a high mobility and smaller diameter of the RCA comparing with the LAD. These results are in line with previous reports and point out that a normal coronary anatomy by the MSCT could accurately exclude the presence of the hemodynamically significant CAD [15][16][17] .…”

Section: Discussionsupporting

confidence: 93%

Diagnostic value of noninvasive comprehensive morphological and functional assessment of coronary artery disease

et al. 2019

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Background/Aim. Recently adopted technique, Transthoracic Doppler Echocardiography (TDE) enables the estimate of functional significance of coronary luminal narrowing. A multi-slice computed coronary angiography (MSCT), as one of the most important noninvasive methods, offers us a quite precise visualization of morphological characteristics of atherosclerotic changes in coronary arteries. We have tried to evaluate the most reliable noninvasive approach aimed at the detection of major stenosis on the left anterior descending artery (LAD) and the right coronary artery (RCA). Methods. This study involved 84 patients, with the previously detected atherosclerotic lesions on the LAD and/or RCA by MSCT. The coronary flow reserve (CFR) assessment by TDE with adenosine was obtained in LAD (n = 75); RCA (n = 61), resulting in 136 vessels subjected to the analysis. Invasive coronary angiography (ICA) was performed in all patients within 24 to 48 hours after the CFR as a reference technique. Results. The Cochrans Q test proved a significant statistical difference among these techniques in detection of a significant stenosis on the LAD and RCA (p < 0.01). Further analyses revealed a significant difference between the MSCT and CFR (p < 0.05), MSCT and ICA (p < 0.01), whereas we did not find a significant difference between the CFR and ICA (p > 0.05). The main discrepancies in results among the CFR, ICA and MSCT were noticed concerning intermediate and severe stenosis on the MSCT. The MSCT had a diagnostic accuracy for the LAD 66.67%, for the RCA 75.%, the CFR had for the LAD 90% and for the RCA 81.67%, in detection of significant stenosis. Where the consensus was reached between both techniques, diagnostic accuracy was improved for the LAD 97.33% and the RCA 90 %. Conclusion. Comprehensive noninvasive evaluation of both anatomical and functional imaging in coronary diseases makes the optimal approach for precise, noninvasive assessment of the coronary artery lesions in the coronary arteries.

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Section: Discussionsupporting

confidence: 93%

Diagnostic value of noninvasive comprehensive morphological and functional assessment of coronary artery disease

et al. 2019

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“…Studies have demonstrated that a CFVR ≥ 2 is adequate and relevant to infer the absence of significant coronary occlusion, and is correlated with a favorable prognosis in the context of the coronary artery analyzed 7,10-12,19,21-27 . Several publications have shown that the authors succeed in recording the LAD flow in approximately 90% of cases; this allows high feasibility of the measurement of CFVR by echocardiography, thus corroborating the use of a safe, validated and reproducible method in the clinical practice 5-13 .…”

Section: Introductionmentioning

confidence: 99%

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

Abreu¹,

Lima²,

Diógenes³

et al. 2013

Arquivos Brasileiros De Cardiologia

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Background A coronary flow velocity reserve (CFVR) ≥ 2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease. Objective To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE). Methods 100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of β-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was < 2 and, in group II, CFVR was ≥ 2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values < 0.05 were considered statistically significant. Results At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53±31 vs. 45±32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9±9.3 vs. 61.2±10.8 years; p=0.04), had lower ejection fraction (61±10 vs. 66±6%; p=0.005), higher DPV-Rest (36.81±08 vs. 25.63 ± 06cm/s; p<0.0001) and lower CFVR (1.67 ± 0.24 vs. 2.53 ± 0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40±16 vs. 64.23±16cm/s; p=0.42). β-blocker discontinuation was associated with a 4-fold higher chance of a CFVR < 2 (OR= 4; 95% CI [1.171-13.63], p=0.027). Conclusion DPV-Rest was the main parameter to determine an adequate CFVR. β-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology.

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“…20,21 DSA remains the gold standard for diagnosis of carotid and coronary lesions; however, it is an invasive examination. 27,28 Usually, coronary and carotid/cerebrovascular CT scans needed to be performed separately, exposing patients to more radiation and the contrast agent. [24][25][26] Thanks to the improvement of the temporal and spatial resolution in CT, CTA has been employed as an alterna- All coronary stenosis were demonstrated by DSA.…”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26] Thanks to the improvement of the temporal and spatial resolution in CT, CTA has been employed as an alterna- tive technique for the detection of cerebral, carotid, and coronary artery disease simultaneously. 27,28 Usually, coronary and carotid/cerebrovascular CT scans needed to be performed separately, exposing patients to more radiation and the contrast agent. The new 256-slice CT provides a detector width of 80 mm with a tube rotation time of 0.27 s, together with a temporal resolution of 33.75 ms, with prospective ECG triggering, and iterative reconstruction algorithms.…”

Section: Discussionmentioning

confidence: 99%

Combining Coronary with Carotid and Cerebrovascular Angiography Using Prospective ECG Gating and Iterative Reconstruction with 256‐slice CT

et al. 2014

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Combination of coronary and carotid/cerebrovascular angiography with 256-slice CT scanner with prospective ECG gating and iterative reconstruction produces diagnostic-quality images of the coronary, carotid, and cerebrovascular systems in a single examination, using less contrast medium and a lower radiation dose than when the two examinations are performed separately. This novel technique has high accuracy in detecting significant stenosis in one image setting.

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The Additive Diagnostic Role of Coronary Flow Reserve in Noninvasive Evaluation of Coronary Stenosis on Left Descending Artery Previously Detected by Multislice Computed Tomography

Abstract: Additional assessment of CFR by TDE increase diagnostic accuracy of MSCT angiography in detection of significant coronary artery lesions.

Cited by 6 publications

References 19 publications

Diagnostic value of noninvasive comprehensive morphological and functional assessment of coronary artery disease

Diagnostic value of noninvasive comprehensive morphological and functional assessment of coronary artery disease

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

Combining Coronary with Carotid and Cerebrovascular Angiography Using Prospective ECG Gating and Iterative Reconstruction with 256‐slice CT

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