Abstract
BackgroundCoronary flow reserve (CFR) recording by means of transthoracic echocardiography (TTDE) in all the main distal coronary arteries is a challenge for advanced echocardiography. Validation studies of TTDE versus Doppler-wire (DW) recordings are available for Left Anterior Descending artery (LAD) and the Posterior Descending coronary artery (PD), but lacking for the more technically challenging Left Circumflex coronary artery (LCx).AimTo evaluate the reliability of TTDE in assessing CFR in LCx when compared to the intracoronary Doppler flow-wire gold standard.Methodswe evaluated 5 patients (age = 60 ± 9 years, 5 males) on LCx by TTDE and invasive CFR assessment. TTDE recording was performed using a low-frequency probe, with a four-chamber as a guiding 2D view. The 2 tests were performed on different days and in random order within 48 hours in a blind fashion. Vasodilator stimulus was adenosine, intravenously (140 γ/kg/min × 3–6 min) for TTDE and intracoronary (40 γ bolus) for DW recordings.ResultsCFR values on LCx ranged from 1.9 to 2.8 for DW, and from 2.0 to 3.0 for TTDE, with an overall correlation of R = 0,85 (p = 0,06); normal (CFR > 2.5) or abnormal (CFR < 2.5) value was concordantly identified by the 2 techniques in 4 out 5 cases (80%).ConclusionCFR of LCx artery can be obtained noninvasively with TTDE.
Highlights
Coronary flow reserve (CFR) recording by means of transthoracic echocardiography (TTDE) in all the main distal coronary arteries is a challenge for advanced echocardiography
Several studies concerning coronary flow and CFR recorded in the Left Anterior Descending coronary artery (LAD) and few in the Posterior Descending coronary artery (PD) have been published so far [9-12], and the measurement of CFR by TTDE was validated, by comparing it with intracoronary Doppler recordings (DW) in the same patient and in the same vessel, in some studies [1316]
A normal (CFR > 2,5) or abnormal (CFR < 2,5) value was concordantly identified by the two techniques in 4 out of 5 cases (80%) . (Table 1)
Summary
Validation studies of TTDE versus Doppler-wire (DW) recordings are available for Left Anterior Descending artery (LAD) and the Posterior Descending coronary artery (PD), but lacking for the more technically challenging Left Circumflex coronary artery (LCx). Coronary flow reserve (CFR) recording by means of transthoracic echocardiography (TTDE) in all the main distal coronary arteries is a challenge for advanced echocardiography. Clinical implications of such a possibility are involving an improved indication for invasive exams and for revascularisation, the evaluation of coronary flow after revascularisation, the new generation of stress-echo testing (CFR plus wall motion) and the non-invasive followup of patients [1-8]. A comparison of TTDE with DW for LCx is still lacking
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