Transthoracic measurement of left coronary artery flow reserve improves the diagnostic value of routine dipyridamole-atropine stress echocardiogram
We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test. In 64 patients with suspected or known coro...
Saved in:
Published in | Archives of medical science Vol. 9; no. 5; pp. 802 - 807 |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Poland
Termedia Publishing House
31.10.2013
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test.
In 64 patients with suspected or known coronary artery disease scheduled for coronary angiography DASE with concomitant CFR measurement in LAD was performed.
Coronary flow reserve measurement and calculation were feasible in 83% of patients. The positive predictive value of undetectable LAD flow was 81% for severe LAD disease. Measured values of CFR were in the range 1.3-4.1 (mean: 2.2 ±0.7). Significantly lower CFR was found in patients with LAD disease (1.97 ±0.62 vs. 2.55 ±0.57, p = 0.0015). The optimal cutoff for detecting ≥ 50% stenosis was CFR ≤ 2.1 (ROC AUC 0.776), corresponding with 68% sensitivity and 84% specificity. In patients with negative DASE results 67% of patients with LAD disease had abnormal CFR, whereas in patients with a positive DASE result 92% of patients with normal LAD had normal CFR. The DASE diagnostic accuracy for the detection of coronary artery disease (CAD) increased from 75% to 85% when CFR measurement was added to wall motion abnormality (WMA) analysis. No test with both abnormalities was false positive for the detection of coronary disease.
Incorporation of CFR measurement into WMA-based stress echocardiography is feasible even in an accelerated DASE protocol and can be translated into an approximate gain of 10% in overall test accuracy. |
---|---|
AbstractList | We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test.
In 64 patients with suspected or known coronary artery disease scheduled for coronary angiography DASE with concomitant CFR measurement in LAD was performed.
Coronary flow reserve measurement and calculation were feasible in 83% of patients. The positive predictive value of undetectable LAD flow was 81% for severe LAD disease. Measured values of CFR were in the range 1.3-4.1 (mean: 2.2 ±0.7). Significantly lower CFR was found in patients with LAD disease (1.97 ±0.62 vs. 2.55 ±0.57, p = 0.0015). The optimal cutoff for detecting ≥ 50% stenosis was CFR ≤ 2.1 (ROC AUC 0.776), corresponding with 68% sensitivity and 84% specificity. In patients with negative DASE results 67% of patients with LAD disease had abnormal CFR, whereas in patients with a positive DASE result 92% of patients with normal LAD had normal CFR. The DASE diagnostic accuracy for the detection of coronary artery disease (CAD) increased from 75% to 85% when CFR measurement was added to wall motion abnormality (WMA) analysis. No test with both abnormalities was false positive for the detection of coronary disease.
Incorporation of CFR measurement into WMA-based stress echocardiography is feasible even in an accelerated DASE protocol and can be translated into an approximate gain of 10% in overall test accuracy. INTRODUCTIONWe hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test. MATERIAL AND METHODSIn 64 patients with suspected or known coronary artery disease scheduled for coronary angiography DASE with concomitant CFR measurement in LAD was performed. RESULTSCoronary flow reserve measurement and calculation were feasible in 83% of patients. The positive predictive value of undetectable LAD flow was 81% for severe LAD disease. Measured values of CFR were in the range 1.3-4.1 (mean: 2.2 ±0.7). Significantly lower CFR was found in patients with LAD disease (1.97 ±0.62 vs. 2.55 ±0.57, p = 0.0015). The optimal cutoff for detecting ≥ 50% stenosis was CFR ≤ 2.1 (ROC AUC 0.776), corresponding with 68% sensitivity and 84% specificity. In patients with negative DASE results 67% of patients with LAD disease had abnormal CFR, whereas in patients with a positive DASE result 92% of patients with normal LAD had normal CFR. The DASE diagnostic accuracy for the detection of coronary artery disease (CAD) increased from 75% to 85% when CFR measurement was added to wall motion abnormality (WMA) analysis. No test with both abnormalities was false positive for the detection of coronary disease. CONCLUSIONSIncorporation of CFR measurement into WMA-based stress echocardiography is feasible even in an accelerated DASE protocol and can be translated into an approximate gain of 10% in overall test accuracy. |
Author | Nouri, Aria Szymczyk, Ewa Kasprzak, Jarosław D Krzemińska-Pakuła, Maria Lipiec, Piotr Wejner-Mik, Paulina |
AuthorAffiliation | Department of Cardiology, Medical University of Lodz, Poland |
AuthorAffiliation_xml | – name: Department of Cardiology, Medical University of Lodz, Poland |
Author_xml | – sequence: 1 givenname: Jarosław D surname: Kasprzak fullname: Kasprzak, Jarosław D organization: Department of Cardiology, Medical University of Lodz, Poland – sequence: 2 givenname: Paulina surname: Wejner-Mik fullname: Wejner-Mik, Paulina – sequence: 3 givenname: Aria surname: Nouri fullname: Nouri, Aria – sequence: 4 givenname: Ewa surname: Szymczyk fullname: Szymczyk, Ewa – sequence: 5 givenname: Maria surname: Krzemińska-Pakuła fullname: Krzemińska-Pakuła, Maria – sequence: 6 givenname: Piotr surname: Lipiec fullname: Lipiec, Piotr |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24273560$$D View this record in MEDLINE/PubMed |
BookMark | eNpVkUtv1TAQRi1URB-wZoe8ZJNbPxLH3iChipdUiU1ZW3Ptyb1GSRxs56L-Dv4wDi0VrMaa-Xzs0bkkZ3OckZDXnO06zttriFPeCcblTmrVy2fkgmujGsM7flbPvWwbboQ4J5c5f2esrR3-gpyLVvSyU-yC_LpLMOdyjAlccHRCyGvCCedC40BHHAp1McUZ0j2FVLCWYYw_acKM6YQ0TEuKJ8y0HJH6AIc55lJBJxhX3BApriXM22y5T8HDFEdsoKS4bN1cKihTdMfoIPkQDwmml-T5AGPGV4_1inz7-OHu5nNz-_XTl5v3t42TRpbG-1aj1MiV2jOPDjuDiErroZWyg0EoDi14NhjNvDLO9cpwqcGg8arfe3lF3j1wl3U_oXd16QSjXVKY6ro2QrD_T-ZwtId4slJLoUVXAW8fASn-WDEXO4XscBxhxrhmy1tlBOeGyRq9foi6FHNOODw9w5ndVNpNpd1U2j8q6403__7uKf_XnfwNmAqjhg |
CitedBy_id | crossref_primary_10_17116_jnevro2017117121116_123 |
ContentType | Journal Article |
Copyright | Copyright © 2013 Termedia & Banach 2013 |
Copyright_xml | – notice: Copyright © 2013 Termedia & Banach 2013 |
DBID | NPM AAYXX CITATION 7X8 5PM |
DOI | 10.5114/aoms.2013.38673 |
DatabaseName | PubMed CrossRef MEDLINE - Academic PubMed Central (Full Participant titles) |
DatabaseTitle | PubMed CrossRef MEDLINE - Academic |
DatabaseTitleList | PubMed MEDLINE - Academic |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1896-9151 |
EndPage | 807 |
ExternalDocumentID | 10_5114_aoms_2013_38673 24273560 |
Genre | Journal Article |
GroupedDBID | --- 23N 2NK 2WC 3EA 3V. 53G 5GY 7X7 8FI 8FJ AAWTL ABMXE ABUWG ACIHN ADBBV ADRAZ AEAQA AENEX AFKRA AHMBA ALIPV ALMA_UNASSIGNED_HOLDINGS AOIJS BAWUL BCNDV BENPR BPHCQ BVXVI BYOGL CCPQU DIK E3Z EBS EJD FYUFA GROUPED_DOAJ GX1 HMCUK HYE KQ8 M48 M~E NPM OK1 P2P P6G PGMZT PIMPY PQQKQ PROAC RNS RPM TR2 UKHRP XSB Y2W AAYXX ABDBF C1A CITATION EOJEC OBODZ 7X8 5PM |
ID | FETCH-LOGICAL-c393t-dd48e38e166b0dece59eee688f4335af261a4ad0f980d69cc769138a9e9d67bd3 |
IEDL.DBID | RPM |
ISSN | 1734-1922 |
IngestDate | Tue Sep 17 20:57:32 EDT 2024 Fri Aug 16 08:03:42 EDT 2024 Fri Aug 23 02:04:16 EDT 2024 Sat Sep 28 07:55:03 EDT 2024 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 5 |
Keywords | stress echocardiography coronary circulation cardiac ultrasound |
Language | English |
License | This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c393t-dd48e38e166b0dece59eee688f4335af261a4ad0f980d69cc769138a9e9d67bd3 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832825/ |
PMID | 24273560 |
PQID | 1469211903 |
PQPubID | 23479 |
PageCount | 6 |
ParticipantIDs | pubmedcentral_primary_oai_pubmedcentral_nih_gov_3832825 proquest_miscellaneous_1469211903 crossref_primary_10_5114_aoms_2013_38673 pubmed_primary_24273560 |
PublicationCentury | 2000 |
PublicationDate | 20131031 |
PublicationDateYYYYMMDD | 2013-10-31 |
PublicationDate_xml | – month: 10 year: 2013 text: 20131031 day: 31 |
PublicationDecade | 2010 |
PublicationPlace | Poland |
PublicationPlace_xml | – name: Poland |
PublicationTitle | Archives of medical science |
PublicationTitleAlternate | Arch Med Sci |
PublicationYear | 2013 |
Publisher | Termedia Publishing House |
Publisher_xml | – name: Termedia Publishing House |
References | 19202146 - Eur J Echocardiogr. 2009 Jul;10 (5):607-12 19222128 - Clin Physiol Funct Imaging. 2009 Apr;29(2):151-7 16365209 - Circulation. 2005 Dec 20;112(25):3892-900 19478706 - Med Sci Monit. 2009 Jun;15(6):CS89-94 20802410 - Med Sci Monit. 2010 Sep;16(9):CR397-404 19270054 - Eur J Echocardiogr. 2009 Mar;10 (2):194-212 19549700 - Eur J Echocardiogr. 2009 Oct;10 (7):813-25 18385014 - J Am Soc Echocardiogr. 2008 Aug;21(8):941-7 14622441 - Cardiovasc Ultrasound. 2003 Nov 17;1:16 15792499 - Cardiovasc Ultrasound. 2005 Mar 25;3:8 17765820 - J Am Soc Echocardiogr. 2007 Sep;20(9):1021-41 18579481 - Eur J Echocardiogr. 2008 Jul;9(4):415-37 20451804 - J Am Soc Echocardiogr. 2010 May;23 (5):553-9 18296409 - Eur J Echocardiogr. 2008 Jul;9(4):449-57 10978972 - Echocardiography. 2000 Feb;17 (2):141-50 21126613 - Am J Cardiol. 2010 Dec 15;106(12):1703-8 15618026 - Eur Heart J. 2005 Mar;26(6):607-16 |
References_xml | |
SSID | ssj0041731 |
Score | 1.99889 |
Snippet | We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated... INTRODUCTIONWe hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated... |
SourceID | pubmedcentral proquest crossref pubmed |
SourceType | Open Access Repository Aggregation Database Index Database |
StartPage | 802 |
SubjectTerms | Clinical Research |
SummonAdditionalLinks | – databaseName: Scholars Portal Journals: Open Access dbid: M48 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1LT-MwELZ4SCsuCFh2t7xkpD3sJd20dvw4IYRACKmcqMQtcu2JqNQm3TQ8-jv4w8wkpWyBA6coseVE_saZb8YzY8Z-D5zDX55XkZXkrcI1FdnEdsnNEaSWHpUuJTj3rtVlX17dJrdvxwHNJ3D6qWlH50n1y1H76d_sBBc88tc20gX51xVjKrzdEW1hlBarbL0rhSRx78nFloLs6PpwQrzICGlNt6nz89kAyyrqA-98Hz75nz662GKbcyLJTxvkt9kK5DvsW2--Vf6dPddaqLpDiP3Q8_GbL5AXGR9BVnFP1QtcOeN1XOeMZ6PikVM6UvkAfFh7G2DKkSHy0ATk4as4VQcHGqIsUGZzapvMymFw42IEEXnWJ_S0yUHhgBPs65BXigLbZf2L85uzy2h-AkPkhRVVFII0IAx0lBrEAShlCwCUMZkUInEZml9OuhBn1sRBWe-1sh1hnAUblB4E8YOt5UUOvxj32psMfxYGZUPKJHESLb2u1rH3IhPKt9if10lPJ02hjRQNFMInJXxSwiet8Wmx41dQUlwMtMPhcijup2THWCpZF2Ofnw1Ii8GQi2iB_K7F9BJ8iw5UaHu5JR_e1QW30YqnFN-9r3_iPtugm0bJHbC1qryHQ2Qv1eColsoXBEXyNg priority: 102 providerName: Scholars Portal |
Title | Transthoracic measurement of left coronary artery flow reserve improves the diagnostic value of routine dipyridamole-atropine stress echocardiogram |
URI | https://www.ncbi.nlm.nih.gov/pubmed/24273560 https://search.proquest.com/docview/1469211903 https://pubmed.ncbi.nlm.nih.gov/PMC3832825 |
Volume | 9 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1La9wwEBZJCqWX0ne3j0WFHnrxrncl63FsQ0IobAilgb0ZWRoTw9peHKdlf0f_cGfkdZq0t15ssGRb-BtrHpr5xNjHwjmc8rxKrKRoFf5Tic3sksIcQWrpUelSgfPqXJ1dyq_rbH3AsrEWJibt-6KaNZt61lRXMbdyW_v5mCc2v1gdo1dFJZfzQ3aohRhd9GH6lQsdNyHEk0zQfFkOfD5oV8i5a2ti6F6ImTBK0xY6qKC0yCI_5R2t9I-p-XfG5B0VdPqEPd7bjvzzMMan7ACaZ-zhar86_pz9ioqnv0JUfeV5_Sf8x9uSb6DsuSfCAtfteEzl3PFy0_7kVIHU_QBexQADXHM0CnkYcvDwVZwIwYEe0bUopg21bXddFVzdbiChYPqWrg5lJxxwQvUxy5USv16wy9OT78dnyX7ThcQLK_okBGlAGFgoVaQBqEoLAJQxpRQicyV6XE66kJbWpEFZ77WyC2GcBRuULoJ4yY6atoHXjHvtTYnzg0FxkDLLnETnbql16r0ohfIT9mn86Pl24NbI0SchqHKCKieo8gjVhH0YQclR_mlRwzXQ3lyT62KJpS7FPq8GkG4fNqI7YfoefLcdiFv7fguKXOTY3ovYm_--8y17RMMf1Nw7dtR3N_Ae7Ze-mKLUrvWUPfhycn7xbRqjAHhcSTONkvwbz6v4lA |
link.rule.ids | 230,315,733,786,790,870,891,2236,24346,27955,27956,31753,33778,53825,53827 |
linkProvider | National Library of Medicine |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwELZKkYAL5VVYWsBIHLgkm107fhxR1WqBbsWhRb1Fju2oEZtklWZBy9_gDzPjbEpbTnCKFDsvzYznkW8-E_IuNwaWPCsizbFaBTYV6VRPsczhuOQWnC42OM9PxOyMfzpPz7dIOvTCBNC-zcu4XlRxXV4EbOWysuMBJzb-Mj-ArApbLsd3yF2w12k6JOn9AswnMmxDCAceQQAz7Rl9ILLgY9NUyNE9YTFTQuImOuCiJEsDQ-U1v_RXsHkbM3nNCR3tkK_D6_fYk2_xqstj-_MWs-M_f98j8nATltIP_fBjsuXrJ-TefPPj_Sn5FXxadwEKY0tLqz-VRdoUdOGLjlrkQjDtmgaU6JoWi-YHxeam9runZahd-EsK8SZ1PbwPHkWRa9zjLdoGLKDGseW6LZ2pmoWPsE6_xLN9Rwv1sFbbAKBFTNkzcnZ0eHowizb7OUSWadZFznHlmfITIfLEeWwA894LpQrOWGoKSOYMNy4ptEqc0NZKoSdMGe21EzJ3bJds103tXxBqpVUFLD0KNI3zNDUc8saplIm1rGDCjsj7QZrZsqftyCDdQR3IUAcy1IEs6MCIvB2knYFp4f8SU_tmdYlZkUYCvATmPO-lf3WzQW1GRN7Qi6sJSNt9cwSkHei7N9J9-d9XviH3Z6fz4-z448nnPfIAP6X3pvtku2tX_hWESV3-OhjFbz8gFkg |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3LbtQwFLWgSBUbKO-BAkZiwSaPGTt2vKxaRuUxVRdUqthEju2oEZOH0gxo-A1-mHudSZmWXVeRJp5Els_1feTcY0Le51rDlmdEoDhWq8CmApWoGZY5LJfcgNPFBufFiTg-45_Pk_Oto748ad_kZVgvq7AuLzy3sq1MNPLEotPFIWRV2HIZtbaI7pJ7YLMzOSbqwybMp9IfRQgXHkAQMxtUfSC64JFuKtTpnrKQpULiQTrgpiRLvErllm_6L-C8yZvcckTzh-T7OIWBf_IjXPV5aH7fUHe81Rz3yINNeEoPhiGPyB1XPya7i80H-Cfkj_dt_QUAx5SGVv8qjLQp6NIVPTWoiaC7NfVs0TUtls0vik1O3U9HS1_DcJcU4k5qB5ofvIqi5rjDR3QNWEKN99p1V1pdNUsXYL2-xV-HzhbqYM82nkiL3LKn5Gz-8dvhcbA51yEwTLE-sJanjqVuKkQeW4eNYM45kaYFZyzRBSR1mmsbFyqNrVDGSKGmLNXKKStkbtkzslM3tXtBqJEmLWALSgFxnCeJ5pA_zqSMjWEFE2ZCPowrmrWDfEcGaQ_iIEMcZIiDzONgQt6NK56BieF3E127ZnWJ2ZFCIbwYxjwfEHD1sBE6EyKvYeNqAMp3X78DK-5lvDcr_PLW_3xLdk-P5tnXTydfXpH7OJPBqe6Tnb5budcQLfX5G28XfwHI9hjI |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Transthoracic+measurement+of+left+coronary+artery+flow+reserve+improves+the+diagnostic+value+of+routine+dipyridamole-atropine+stress+echocardiogram&rft.jtitle=Archives+of+medical+science&rft.au=D.+Kasprzak%2C+Jaros%C5%82aw&rft.au=Wejner-Mik%2C+Paulina&rft.au=Nouri%2C+Aria&rft.au=Szymczyk%2C+Ewa&rft.date=2013-10-31&rft.issn=1734-1922&rft.volume=5&rft.spage=802&rft.epage=807&rft_id=info:doi/10.5114%2Faoms.2013.38673&rft.externalDBID=n%2Fa&rft.externalDocID=10_5114_aoms_2013_38673 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1734-1922&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1734-1922&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1734-1922&client=summon |