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CLINICAL STUDY

Physiologic assessment of coronary artery stenosis by coronary flow reserve measurements with transthoracic doppler echocardiography: comparison with exercise thallium-201 single-photon emission computed tomography

^a Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan

Manuscript received April 7, 2000; revised manuscript received December 13, 2000, accepted December 28, 2000.

Reprint requests and correspondence: Dr. Hiroyuki Watanabe, Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, Japan
watanabe{at}med.osaka-cu.ac.jp

OBJECTIVES

We evaluated the value of coronary flow reserve (CFR), as determined by transthoracic Doppler echocardiography (TTDE), for physiologic assessment of coronary artery stenosis severity, and we compared TTDE measurements with those obtained by exercise thallium-201 (Tl-201) single-photon emission computed tomography (SPECT).

BACKGROUND

Coronary flow reserve measurements by TTDE have been reported to be useful for assessing angiographic left anterior descending coronary artery (LAD) stenosis. However, discrepancies exist between angiographic and physiologic estimates of coronary lesion severity.

METHODS

We studied 36 patients suspected of having coronary artery disease. The flow velocity in the distal LAD was measured by TTDE both at rest and during intravenous infusion of adenosine. Coronary flow reserve was calculated as the ratio of hyperemic to basal peak (peak CFR) and mean (mean CFR) diastolic flow velocities. The CFR measurements by TTDE were compared with the results of Tl-201–SPECT.

RESULTS

Complete TTDE data were acquired for 33 of 36 study patients. Of these 33 patients, Tl-201–SPECT confirmed reversible perfusion defects in the LAD territories in 12 patients (group A). Twenty-one patients had normal perfusion in the LAD territories (group B). Peak CFR and mean CFR (mean value ± SD) were 1.5 ± 0.6 and 1.5 ± 0.7 in group A and 2.8 ± 0.8 and 2.7 ± 0.7 in group B, respectively. Both peak and mean CFR 2.0 predicted reversible perfusion defects, with a sensitivity and specificity of 92% and 90%, respectively.

CONCLUSIONS

Noninvasive measurement of CFR by TTDE provides data equivalent to those obtained by Tl-201–SPECT for physiologic estimation of the severity of LAD stenosis.

Abbreviations and Acronyms   ANOVA = analysis of variance   CFR = coronary flow reserve   LAD = left anterior descending coronary artery   LV = left ventricular/left ventricle   SPECT = single-photon emission computed tomography   Tl-201 = thallium-201   TTDE = transthoracic Doppler echocardiography

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