Non-invasive evaluation of coronary reserve: Assessment of coronary reserve in patients with coronary artery disease by transesophageal-Doppler echocardiography

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Abstract

We assessed coronary flow reserve using transesophageal Doppler echocardiography in patients with coronary artery disease. The study included 33 coronary artery disease patients who were undergoing coronary arteriography. The blood flow velocities of the left anterior descending artery before and after intravenous infusion (0.56 mg/min for 4 min) of dipyridamole were recorded using transesophageal Doppler echocardiography. Fourteen normal healthy individuals, matched for age, served as a control group. The index of coronary flow reserve, i.e. the ratio of dipyridamole to baseline maximum diastolic velocity, was calculated. Maximal coronary flow reserve in coronary artery disease patients was significantly lower than in the control group (1.4±0.2 vs. 2.8±0.3, P<0.001). The coronary artery disease patients were classified into three groups: Group A included 10 patients with <50% left anterior descending artery stenosis; Group B included seven patients with 50–69% left anterior descending artery stenosis; 16 patients with >70% left anterior descending artery stenosis constituted Group C. The maximum coronary flow reserve was significantly different for A vs. B and A vs. C. (A, 1.77±0.18; B, 1.51±0.1; C, 1.28±0.24). A strong and significant correlation was found between the maximum coronary flow reserve and the degree of proximal left anterior descending artery stenosis (r=0.78, P<0.001). Coronary artery disease patients without left anterior descending artery stenosis on the arteriogram exhibited lower maximum coronary flow reserve compared to the control subjects (1.78±0.19 vs. 2.8±0.3, P=0.000).

Introduction

Coronary arteriography is the usual method for evaluating the anatomy of the coronary arteries, for detecting the site, extension and degree of stenoses of the arteries and for estimating the extent of the collateral circulation. However, it is well known that the functional consequences of arterial lumen narrowing cannot be assessed accurately with coronary arteriography. Coronary flow reserve, the difference between maximal and baseline flow, can contribute to the estimation of the functional consequences of anatomical stenosis of the coronary artery [1].

Coronary flow reserve can be calculated using invasive 2, 3, 4and non-invasive 5, 6, 7methods. Views of the proximal parts of the coronary arteries can be easily obtained with the use of transesophageal-Doppler echocardiography and the blood flow in the proximal part of the left anterior descending artery can be recorded with the use of pulsed Doppler. Measurements of coronary flow reserve by transesophageal echocardiography have already been reported 8, 9.

The aim of this study was the assessment of coronary flow reserve by transesophageal echocardiography in patients with coronary artery disease, the evaluation of the relation between coronary flow reserve and the degree of arterial stenosis and the estimation of coronary flow reserve in the absence of angiographical stenosis.

Section snippets

Materials and methods

Patients with a history of angina were studied. Coronary arteriography, using Judkins' technique [10], was performed in all patients and the arteriograms were interpreted by two cardiologists blinded to the results of the study. Stenosis were evaluated using multiple projections and were classified as significant if they narrowed the arterial lumen by 50% or more. Patients with valvular disease, congenital heart disease, arrhythmia, hypertension, heart rate >80 beats/min, or

Results

Clinical and transthoracic echocardiography results for the 33 patients with coronary artery disease are shown in Table 1. The left anterior descending artery flow velocity waveform in coronary artery disease patients and in the control group consisted of two waves, with the diastolic one being the greater (Fig. 1).

Left anterior descending artery stenosis, maximum systolic and diastolic velocities in the initial part of the left anterior descending artery under baseline conditions and after

Discussion

In the present study, measurements of coronary flow reserve with the use of transesophageal echocardiography and the infusion of dipyridamole were found to be feasible and safe in patients with left anterior descending artery stenosis and in healthy individuals. Previous studies have shown similar results. Specifically, Iliceto et al. [8]and Hutchison et al. [11]managed to estimate coronary flow reserve with transesophageal echocardiography after infusion of a vasodilator agent in all the

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