Abstract
More than half of the patients with symptoms suggestive of myocardial ischemia presenting at invasive angiography have no obstructive coronary artery disease (CAD). A large proportion of these patients have ischemia caused by coronary microvascular dysfunction, a condition associated with adverse cardiovascular prognosis. Measurement of coronary flow velocity reserve by transthoracic Doppler echocardiography is a feasible and reproducible method for the evaluation of coronary microvascular function. This review provides a practical overview of the method in a clinical setting of angina and noobstructive CAD, including technical details and prognostic significance.
Highlights
Simultaneous assessment of left ventricular regional wall motion can be performed during dipyridamole and adenosine infusions [22]
Published reports show that TTDE coronary flow velocity reserve (CFVR) in the left anterior descending artery (LAD) is highly reproducible in experienced hands
Low intra- and interreader variations have been reported by several research groups, suggesting good reproducibility of CFVR [6, 28, 32]. e good repeatability and reproducibility of TTDE CFVR supports the use of CFVR in serial evaluations in both clinical and research settings, as well as an outcome measure
Summary
Summary of noninvasive assessment of coronary microvascular function by transthoracic Doppler echocardiography Physiological pathway: nonendothelial dependent Preferred coronary artery: left anterior descending artery Measurement: coronary flow velocity reserve (CFVR) ratio of hyperemic to resting coronary flow velocities (m/s); continuous scale Cutoff for coronary microvascular dysfunction: CFR
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