Continuous-Wave Doppler Echocardiographie Evaluation of Patients with Coronary Artery Disease

Abstract

To investigate the usefulness of continuous-wave Doppler echocardiography from the suprasternal notch in the evaluation of patients with coronary artery disease (CAD) during exercise, ascending aortic blood flow was recorded using the Doppler method during treadmill exercise testing. Doppler-derived peak aortic velocity, stroke volume, and cardiac output were compared in patients with CAD (n = 34, mean age 57 years) with that of normal subjects (n = 21, mean age 35 years). Coronary angiography was performed in all 34 patients with CAD; supine ergometer exercise testing with simultaneous measurement of pulmonary artery wedge pressure (PAWP) was conducted in 18. The patients were classified according to (1), the extent of CAD (single-vessel disease, n = 22; multivessel disease, n = 12) and (2) to the extent of exercise-induced elevation in PAWP (marked elevation ≥ 20 mm Hg, n = 8; < 20 mm Hg, n = 10) at peak exercise. There were no significant differences between Doppler-derived variables in normal subjects and those in patients with single-vessel disease with and without ischemic ECG changes. In contrast, patients with multivessel disease or patients with marked elevation in PAWP induced by exercise showed a significantly lower increase in Doppler-derived variables than the other groups. These findings suggest that exercise-induced changes in continuous-wave Doppler-derived variables can be used to distinguish between patients with and without multivessel CAD and patients with and without abnormal elevations in left ventricular filling pressure during dynamic upright exercise testing.