Non-invasive evaluation of coronary flow reserve with transthoracic Doppler echocardiography predicts the presence of significant stenosis in coronary arteries (original) (raw)
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Circulation, 2001
Background-We hypothesized that coronary blood flow (CBF) reserve could be quantified noninvasively in humans using myocardial contrast echocardiography (MCE). Methods and Results-Eleven patients with normal epicardial coronary arteries (group I) and 19 with single-vessel coronary stenosis (group II) underwent quantitative coronary angiography, MCE, and CBF velocity measurements at rest and during intravenous adenosine infusion. In group I patients, MCE-derived myocardial blood flow (MBF) velocity reserve (2.4Ϯ0.08) was similar to CBF velocity reserve using a Doppler flow wire (2.4Ϯ1.1). Patients with a single risk factor had a significantly higher MBF reserve (3.0Ϯ0.89) than those with Ն2 risk factors (1.7Ϯ0.22). In group II patients, significant differences were found in MBF velocity reserve in patients with mild (Ͻ50%), moderate (50% to 75%), or severe (Ͼ75%) stenoses (2.2Ϯ0.40, 1.6Ϯ0.65, and 0.55Ϯ0.19, respectively; Pϭ0.005). A linear relation was found between flow velocity reserve determined using the 2 methods (rϭ0.76, PϽ0.001), and a curvilinear relation was noted between the percent coronary stenosis measured using quantitative coronary angiography and velocity reserve using both methods.
Journal of Interventional Cardiology, 2002
The human circulation to the human myocardium is unique in multiple ways. There is a great need for oxygenated blood supply to the myocardial muscle. The heart mainly operates on aerobic metabolism. Since the coronary arterial oxygen extraction is at near maximal level (coronary sinus oxygen saturation 25-35%),' myocardial blood flow and oxygenation are critically dependent on coronary vasodilator reserve. Coronary flow reserve (CFR) is defined as the maximal extent of coronary flow relative to the baseline flow elicited by a potent pharmacological stimulus. CFR is a ratio of maximally elicited coronary flow to resting flow. It is 2-5 in humans and 4-7 in experimental animals. Coronary flow stimulators include transient coronary occlusion, angiographic contrast, intracoronary nitroglycerin, adenosine, bradykinin, and papaverine. CFR represents the maximal vasodilator capacity of the total coronary vascular bed largely comprising of the microvascular network and conduit epicardial vessels. CFR is inversely proportional to coronary microvascular resistance if the conduit vessels are normal. Coronary vascular resistance is coronary perfusion pressure divided by basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am J Cardiol 1974;33:87-94. Pinch C, Schwaiger M. The clinical role of positron emission tomography in management of the cardiac patient. Rev Port Cardiol2ooO. l9(Suppl. 1):189-I 100. Donohue TJ, Kern MJ. Aguirre FV, et al. Assessing the hemodynamic significance of coronary artery stenoses: Analysis of translesional pressure-flow velocity relations in patients. J Am
American Heart Journal, 2008
Doppler-derived coronary flow velocity reserve (CFVR) of left anterior descending (LAD) artery is an effective tool to predict overall mortality. The aim was to investigate the capability of CFVR to predict outcome in an unselected cohort of patients older than 80 years having stress echo negative by wall motion criteria. Methods and results The study group refers to 369 patients aged .80 years (156 men; mean age 83 + 2 years) who had undergone dipyridamole stress echocardiography with CFVR assessment of LAD artery of known (n ¼ 144) or suspected (n ¼ 225) coronary artery disease. Stress echocardiography was negative for wall motion criteria in all cases. Mean CFVR was 2.07 + 0.53. During a median follow-up of 21 months, there were 62 major adverse cardiac events (MACEs; 45 deaths and 17 non-fatal myocardial infarctions). With a receiver operating characteristic analysis, a CFVR of ≤1.93 was the best cutoff for predicting mortality and MACE. At individual patient analysis, 152 (41%) subjects had a CFVR of ,1.93. Annual mortality was 9.8% in patients with CFVR ,1.93 and 3.7% in those with CFVR .1.93 (P ¼ 0.001); an annual MACE rate was 14.8% in the former and 4.5% in the latter (P , 0.0001). Of 15 clinical and echocardiographic parameters analysed, CFVR ≤1.93 [hazard ratio (HR) ¼ 2.17, 95% CI 1.14-4.10] and resting wall motion abnormality (RWMA; HR ¼ 2.60; 95% CI 1.35-5.00) were multivariable indicators of mortality. Moreover, CFVR ≤1.93 (HR ¼ 2.69, 95% CI 1.56-4.67), and RWMA (HR ¼ 2.38; 95% CI 1.31-4.33) were also strong independent predictors of MACEs. At incremental analysis, CFR ≤1.93 added prognostic information over clinical evaluation and RWMA when both mortality and MACE were taken as clinical end points. Conclusions A reduced CFVR of LAD artery is a strong and independent indicator of both mortality and MACE, adding prognostic information over clinical evaluation and RWMA. Conversely, a preserved CFVR predicts a favourable outcome particularly in subjects with no RWMA.
The American Journal of Cardiology, 1995
Although quantitative coronary angiography (QCA) has been used to determine lesion severity, angiographically derived parameters of translesional physiology have not been compared with those directly measured in the same patients. Thus, the aim of this study was to correlate QCA-derived translesional pressure and flow data with directly measured data in patients. QCA (DCI-ACA program), translesional pressure gradient (2.2Fr fluid-filled tracking catheter), and intracoronary Doppler flow velocity (0.018-inch FloWire) measurements were simultaneously performed in 28 arteries (25 patients). Mean diameter stenosis was 51 +/- 2.3% (range 29 to 73). No patient had left ventricular hypertrophy or valvular heart disease. The arteries studied were left anterior descending in 14, circumflex in 8, and right coronary in 6 patients. Stenotic flow reserve and baseline and maximal gradients were calculated by the DCI program. Coronary flow reserve and baseline and maximal hyperemic gradients were also directly measured distal to the stenosis after administration of intracoronary adenosine (12 to 18 micrograms). QCA-derived pressure gradients did not correlate with the measured gradients at baseline (r2 = 0.005; p = 0.73) or at maximal hyperemia (r2 = 0.1; p = 0.13). No correlation was found between the QCA-predicted flow reserve and the coronary flow reserve measured distal to the stenosis (r2 = 0.02; p = 0.46). Furthermore, stenotic flow reserve and measured gradient were not significantly correlated (r2 = 0.1; p = 0.16). In this range of stenoses of intermediate severity, there was no correlation between the measured pressure gradient or coronary flow reserve and lesion diameter or cross-sectional area by QCA.(ABSTRACT TRUNCATED AT 400 WORDS)
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2008
Transthoracic Doppler echocardiography, introduced in the echo-lab in recent last years, to measure coronary flow and coronary flow reserve, is a very attractive tool, totally non-invasive, and easily available at bedside. This review summarizes the actual possibilities of this tool, its multiple potential clinical applications and diagnostic insights, and its arising prognosis value, in coronary artery disease as in various settings affecting the coronary microcirculation.
Echocardiography, 2010
Objective: Coronary flow velocity reserve (CFR) by pulsed Doppler echocardiography is a useful hemodynamic index to evaluate the coronary microcirculatory dysfunction in the left anterior descending coronary artery (LAD). The present study was designed to evaluate the long-term predictive value of CFR for mortality in patients with right (RC) and/or left circumflex coronary artery (CX) stenosis without epicardial LAD disease. Methods: A total of 49 patients with significant RC and/or CX stenosis were enrolled in this prospective follow-up study. All patients had undergone coronary angiography demonstrating significant RC and/or CX stenosis without LAD disease and dipyridamole stress transoesophageal echocardiography as CFR measurement. Results: The success rate of follow-up was 43 out of 49 (88%). During a mean follow-up of 97 ± 29 months, 14 patients suffered cardiovascular deaths (12 sudden cardiac deaths and 2 strokes), and 1 patient died of pulmonal tumor. Patients who died during the follow-up had significantly lower CFR values (1.85 ± 0.43 vs. 2.31 ± 0.57, P < 0.05). Using ROC analysis, CFR <2.09 had the highest accuracy in predicting cardiovascular survival (sensitivity 80%, specificity 57%, area under the curve 73%, P = 0.003). The logistic regression model identified only CFR as an independent predictor of survival (hazard ratio [HR] 6.26, 95% CI of HR 1.23-19.61, P = 0.024). Conclusions: Long-term prognostic significance of CFR for the prediction of mortality has been demonstrated during a 9-year follow-up in patients with significant coronary artery disease not involving the LAD. (Echocardiography 2010;27:306-310)