Transthoracic echocardiography for imaging of the different coronary artery segments: a feasibility study

Johnny Vegsundvåg,Torstein Hole,Espen Holte,Knut Hegbom,Rune Wiseth

doi:10.1186/1476-7120-7-58

Abstract

BackgroundTransthoracic echocardiography (TTE) may be used for direct inspection of various parts of the main coronary arteries for detection of coronary stenoses and occlusions. We aimed to assess the feasibility of TTE to visualise the complete segments of the left main (LM), left descending (LAD), circumflex (Cx) and right (RCA) coronary arteries.MethodsOne hundred and eleven patients scheduled for diagnostic coronary angiography because of chest pain or acute coronary syndrome had a TTE study to map the passage of the main coronary arteries. LAD, Cx and RCA were each divided into proximal, middle and distal segments. If any part of the individual segment of a coronary artery with antegrade blood flow was not visualised, the segment was labeled as not satisfactorily seen.ResultsComplete imaging of the LM was achieved in 98% of the patients. With antegrade directed coronary artery flow, the proximal, middle and distal segments of LAD were completely seen in 96%, 95% and 91% of patients, respectively. Adding the completely seen segments with antegrade coronary flow and segments with retrograde coronary flow, the proximal, middle and distal segments of LAD were adequately visualised in 96%, 96% and 93% of patients, respectively. With antegrade directed coronary artery flow, the proximal, middle and distal segments of Cx were completely seen in 88%, 61% and 3% and in RCA in 40%, 28% and 54% of patients. Retrograde coronary artery flow was correctly identified as verified by coronary angiography in seven coronary segments, mainly in the posterior descending artery (labeled as the distal segment of RCA) and distal LAD.ConclusionsTTE is a feasible method for complete demonstration of coronary flow in the LM, the proximal Cx and the different segments of LAD, but less suitable for the RCA and mid and distal segments of the Cx. (ClinicalTrials.gov number NTC00281346.)

Highlights

Transthoracic echocardiography (TTE) may be used for direct inspection of various parts of the main coronary arteries for detection of coronary stenoses and occlusions
Left anterior descending artery Adding the patients with completely seen segments with antegrade coronary flow and patients with segmental retrograde coronary flow, the proximal, middle and distal segments of left anterior descending coronary artery (LAD) were adequately visualised in 96%, 96% and 93% of the patients, respectively (Table 2)
Coronary angiography demonstrated total occlusion of LAD in these cases with collateral flow to the occluded artery in Rentrop class ≥ 2. Visualisation of both left main (LM) and proximal LAD (pLAD) or LM and pLAD/middle segment of LAD (mLAD) was achieved in 95% and 90% of the patients (Table 3)

Summary

Introduction

Transthoracic echocardiography (TTE) may be used for direct inspection of various parts of the main coronary arteries for detection of coronary stenoses and occlusions. We aimed to assess the feasibility of TTE to visualise the complete segments of the left main (LM), left descending (LAD), circumflex (Cx) and right (RCA) coronary arteries. Non-invasive imaging of coronary arteries by transthoracic echocardiography (TTE) is an emerging diagnostic tool for studying flow in the left main (LM), the left descending artery (LAD), the circumflex (Cx) and the right coronary arteries (RCA) [1,2]. The aim of this study was to assess the feasibility of TTE to visualise the complete segments of the LM, LAD, Cx and RCA in a larger set of patients

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