CLINICAL STUDY
Assessment of coronary flow velocity with transthoracic Doppler echocardiography during dobutamine stress echocardiography
Masaaki Takeuchi, MD*,
Chinami Miyazaki, MD*,
Hidetoshi Yoshitani, MD*,
Shinichiro Otani, MD*,
Kazuo Sakamoto, MD* and
Junichi Yoshikawa, MD
* Department of Internal Medicine, Tane General Hospital, Osaka, Japan
Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan
Manuscript received November 15, 2000;
revised manuscript received March 7, 2001,
accepted March 23, 2001.
Reprint requests and correspondence: Dr. Masaaki Takeuchi, Department of Internal Medicine, Tane General Hospital, 1-2-31 Sakaigawa, Nishi-ku, Osaka, 550-0024 Japan
masaaki_takeuchi{at}hotmail.com
OBJECTIVES
The purpose of this study was to evaluate the feasibility of measuring coronary flow velocity (CFV) by transthoracic Doppler echocardiography (TTDE) in the left anterior descending coronary artery (LAD) during contrast-enhanced dobutamine stress echocardiography (DSE). We also assessed the value of TTDE for detecting stress-induced myocardial ischemia in the LAD territory.
BACKGROUND
Noninvasive assessment of both CFV and wall motion during DSE would enhance the diagnostic accuracy of DSE.
METHODS
One hundred forty-four consecutive patients underwent CFV recording in the distal LAD by TTDE during contrast-enhanced DSE. Regional wall motion score index (WMSI) in the LAD territory and CFV ratio at peak stress (CFV ratio peak), defined as a ratio of CFV at peak stress to basal CFV, were obtained.
RESULTS
Coronary flow velocity was successfully recorded in 129 patients (90%) at baseline and during dobutamine infusion. Mean value of CFV ratio peak was 2.39 ± 0.83 (range: 0.84 to 4.40). There was good correlation between WMSI at peak stress and CFV ratio peak (r = 0.62, p < 0.001). Coronary flow velocity ratio peak was significantly lower in patients who developed stress-induced wall motion abnormality (WMA) in the LAD territory than it was in those patients without WMA (1.51 ± 0.51 vs. 2.76 ± 0.65, p < 0.001). A CFV ratio peak <2.1 had a sensitivity of 92% and a specificity of 86% for detecting the presence of stress-induced WMA.
CONCLUSIONS
Assessment of CFV in the distal LAD during DSE is feasible in the majority of cases and provides a CFV ratio for detecting stress-induced myocardial ischemia in the LAD territory.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | CFV | = coronary flow velocity | | CFVR | = coronary flow velocity reserve | | DSE | = dobutamine stress echocardiography | | LAD | = left anterior descending coronary artery | | MDV | = mean diastolic velocity | | TTDE | = transthoracic Doppler echocardiography | | WMA | = wall motion abnormality | | WMSI | = wall motion score index |
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