Transthoracic Doppler Echocardiography for Detection of Stenoses in the Left Coronary Artery by Use of Poststenotic Coronary Flow Profiles: A Comparison with Quantitative Coronary Angiography and Coronary Flow Reserve

• Published in: Journal of the American Society of Echocardiography Vol. 26; no. 1; pp. 77 - 85
• Main Authors: Holte, Espen, MD, Vegsundvåg, Johnny, MD, Hegbom, Knut, MD, Hole, Torstein, MD, PhD, Wiseth, Rune, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 2013
• Subjects: Cardiovascular; Coronary Angiography - methods; Coronary Circulation; Coronary Stenosis - diagnosis; Coronary Stenosis - physiopathology; Coronary Vessels - diagnostic imaging; Echocardiography, Doppler, Color - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Regional Blood Flow - physiology; Reproducibility of Results; ROC Curve; Severity of Illness Index; Transthoracic Doppler echocardiography; CFVR; LM; TTE; pCFVR; peak coronary flow velocity reserve; Peak diastolic flow velocity; peak diastolic-to-systolic velocity ratio; Cx; NPV; PPV; Coronary flow velocity reserve; Quantitative coronary angiography; Left main coronary artery; Marginal branches of the left circumflex coronary artery; Transthoracic Doppler echocardiography; PDV; Peak systolic flow velocity; Diastolic-to-systolic velocity ratio; Transthoracic echocardiography; Negative predictive value; ROC; CxMb; DSVR; Left anterior descending coronary artery; LAD; QCA; pDSVR; RCA; Right coronary artery; PSV; Receiver operating characteristic; Positive predictive value; Left circumflex coronary artery
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2012.10.001

Background The aim of this study was to determine whether poststenotic diastolic-to-systolic velocity ratio (DSVR) assessed by transthoracic Doppler echocardiography could accurately identify significant stenoses in the left coronary artery. Methods A total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied. Results The success rates of peak DSVR (pDSVR) measurements in the distal to mid left anterior descending coronary artery and marginal branches of the left circumflex coronary artery were 85% and 32%, respectively. With peak coronary flow velocity reserve as a reference, pDSVR was significantly higher in arteries with normal coronary flow reserve (peak coronary flow velocity reserve ≥ 2.0) compared with arteries with reduced coronary flow reserve (peak coronary flow velocity reserve < 2.0) (1.86 ± 0.32 vs 1.53 ± 0.31, P < .0001). In comparison with quantitative coronary angiography, pDSVR was significantly higher in lesions with diameter stenosis < 50% compared with those with diameter stenosis of 50% to 75% (1.92 ± 0.32 vs 1.53 ± 0.18, P < .0001) or diameter stenosis of 76% to 100% (1.43 ± 0.13, P  < .0001). Receiver operating characteristic curves showed pDSVR < 1.68 to be the optimal cutoff value for identifying both functionally significant stenoses and diameter stenoses ≥ 50%, with sensitivity of 86% and 90%, specificity of 74% and 84%, positive predictive value of 51% and 71%, and negative predictive value of 94% and 95%, respectively. Conclusions Transthoracic pDSVR measurements in the distal to mid left anterior descending coronary artery and marginal branches of the left circumflex coronary artery had high accuracy for excluding functionally significant stenoses in the left coronary artery, as well as for identifying angiographic significant stenoses.