Abstract

BackgroundOur aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow.MethodsA total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied using transthoracic Doppler echocardiography.ResultsAnterograde peak diastolic flow velocities (pDV) in septal perforating branches were higher in patients with angiographic occluded contralateral artery compared with corresponding velocities in patients without significant disease in the contralateral artery (0.80 ± 0.31 m/sec versus 0.37 ± 0.13 m/sec, p < 0.001). Receiver operating characteristic curve showed pDV ≥ 0.57 m/sec to be the optimal cutoff value to identify occluded contralateral artery, with a sensitivity of 79% and a specificity of 69%. Demonstration of at least one positive parameter (retrograde flow in main coronary arteries, reversed flow in septal perforating and left circumflex marginal branches, pDV ≥ 0.57 m/sec, or demonstration of other epicardial or intramyocardial collaterals) indicating collateral flow to an occluded main coronary artery had sensitivity, specificity, positive and negative predictive value of 89%, 94%, 63%, and 99%, respectively, for detection of a coronary occlusion. With this combined use of several parameters, 25 of 28 coronary occlusions were identified.ConclusionsBy investigating several parameters indicating collateral flow, we were able to identify most of the main coronary occlusions in the patient cohort. Furthermore, our study demonstrated that coronary artery occlusions may result in complex and diverging coronary pathophysiology depending on which coronary artery segment is occluded and the extent of accompanying coronary artery disease.Trial registrationClinicalTrials.gov number NTC00281346.

Highlights

  • Our aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow

  • Coronary artery occlusions are common in coronary disease, with up to a quarter to a third of patients referred for coronary angiography reported to have coronary occlusions [1,2]

  • Eight patients had dominant Cx with posterior descending coronary artery (PDA) originating from the distal Cx, and in one patient, co-dominance was demonstrated by angiography

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Summary

Introduction

Our aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow. The coronary arteries are interconnected by intramyocardial and epicardial collaterals [6,7]. Enhanced flow in elongated epicardial or intramyocardial vessels has been shown to represent collateral flow to an occluded coronary artery [10,18]. Accelerated anterograde flow velocities in septal perforating branches have been proposed to indicate collateral flow to an occluded artery [17,18]. These TTE studies are few, and most studies have in limited patient cohorts used only one or two parameters to detect coronary occlusions and collateral flow. Anterograde flow velocities in septal perforators with collateral supply to occluded coronary arteries have not been extensively evaluated

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