Abstract
The growing need for coronary evaluation has raised interest in non-radioactive, non-invasive monitoring systems. In particular, radiation exposure during coronary investigations has been shown to be a possible cause of an enhanced risk of secondary tumors. Literature search has indicated that transthoracic echocardiography (TTE) has been widely applied to coronary arteries up to 2003, following which the lack of adequate equipment and the increased availability of invasive diagnostics, has reduced interest in this low cost, low-risk technology. The more recent availability of newer, more sensitive machines, allows evaluation of a larger number of arterial trees, including the aorta in newborns, the prenatal aortic intima-media thickness, as well as the detection of coronary artery anomalies in the adult. Improved technology for this highly operator sensitive technique may thus predict a possible evolution toward the clinical diagnostics of coronary disease and, eventually, also of the progression/regression of disease. We sought to evaluate the present status of this seldom quoted non-invasive technology.
Highlights
A number of invasive and non-invasive methods allows, as of a reliable assessment of the coronary artery status
While the strategy for coronary disease evaluation is quite well accepted, still a number of factors indicate the need for changes in this strategy
The fact that invasive coronary evaluation most frequently leads to a coronary intervention, may be criticized based on the data from
Summary
A number of invasive and non-invasive methods allows, as of a reliable assessment of the coronary artery status. Using a TTE system, about 2 cm of the more proximal part of the artery can be directly visualized by highresolution two-dimensional echo [9] In this early evaluation, it was apparent that LAD wall thickness was about twice higher (1.9 vs 0.9 mm) vs thickness estimated by an intravascular ultrasound (IVUS) in a comparable series of coronary patients [11, 12]. The Authors described a higher echogenicity in the coronaries from patients vs normals [12] This latter observation may fit with the known different mechanical properties of diseased arteries, as assessed by IVUS elastography, in particular a high strain value for fatty vs fibrous plaques, identifying macrophage-rich areas [14]. This early study was followed by more detailed investigations until, very recently Versundsvag et al, after localization of the three main coronaries by US, determined peak systolic
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