Abstract
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.
Highlights
Coronary angiography is the gold standard procedure to assess the severity of coronary artery disease, despite of its well-known limitations [1]
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 left main coronary artery (LM) lesions
The present study was designed to evaluate the potential correlations between intravascular ultrasound (IVUS), quantitative coronary angiography (QCA) and that simple resting Doppler transthoracic echocardiography (TTDE) in angiographically borderline LM lesions, and to determine, whether TTDE could have play a role in the decision making process
Summary
Coronary angiography is the gold standard procedure to assess the severity of coronary artery disease, despite of its well-known limitations [1]. 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 been demonstrated, that simple resting Doppler transthoracic echocardiography (TTDE) is an effective method in assessing hemodynamically significant LM lesions [20,21,22]. The present study was designed to evaluate the potential correlations between IVUS, quantitative coronary angiography (QCA) and TTDE in angiographically borderline LM lesions, and to determine, whether TTDE could have play a role in the decision making process
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
