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CLINICAL STUDY

Assessment of flow velocity reserve by transthoracic Doppler echocardiography and venous adenosine infusion before and after left anterior descending coronary artery stenting

^a Section of Cardiology II, Institute of Cardiac Surgery, University of Rome "La Sapienza," Rome, Italy

Manuscript received August 8, 2000; revised manuscript received March 19, 2001, accepted March 26, 2001.

Reprint requests and correspondence: Dr. Paolo Voci, Via San Giovanni Eudes, 27 00163, Rome, Italy
voci{at}uniroma1.it

OBJECTIVES

We sought to evaluate whether coronary flow velocity reserve (CFR) (the ratio between hyperemic and baseline peak flow velocity), as measured by transthoracic Doppler echocardiography during adenosine infusion, allows detection of flow changes in the left anterior descending coronary artery (LAD) before and after stenting.

BACKGROUND

The immediate post-stenting evaluation of CFR by intracoronary Doppler has shown mixed results, due to reactive hyperemia and microvascular stunning. Noninvasive coronary Doppler echocardiography may be a more reliable measure than intracoronary Doppler.

METHODS

Transthoracic Doppler echocardiography during 90-s venous adenosine infusion (140 µg/kg body weight per min) was used to measure CFR of the LAD in 45 patients before and 3.7 ± 2 days after successful stenting, as well as in 25 subjects with an angiographically normal LAD (control group).

RESULTS

Adequate Doppler spectra were obtained in 96% of the patients. Pre-stent CFR was significantly lower in patients than in control subjects (diastolic CFR: 1.45 ± 0.5 vs. 2.72 ± 0.71, p < 0.01; systolic CFR: 1.61 ± 1.02 vs. 2.41 ± 0.68, p < 0.01) and increased toward the normal range after stenting (diastolic CFR: 2.58 ± 0.7 vs. 2.72 ± 0.75, p = NS; systolic CFR: 2.43 ± 1.01 vs. 2.41 ± 0.52, p = NS). Diastolic CFR was often damped, suggesting coronary steal in patients with 90% versus <90% LAD stenosis (0.86 ± 0.23 vs. 1.69 ± 0.43, p < 0.01). Coronary stenting normalized diastolic CFR in these two groups (2.45 ± 0.77 and 2.64 ± 0.69, respectively, p = NS), even though impaired diastolic CFR persisted in three of four patients with 90% stenosis. Stenosis of the LAD was better discriminated by diastolic (F = 49.30) than systolic (F = 12.20) CFR (both p < 0.01).

CONCLUSIONS

Coronary flow reserve, as measured by transthoracic Doppler echocardiography, is impaired in LAD disease; it may identify patients with 90% stenosis; and it normalizes early after stenting, even in patients with 90% stenosis.

Abbreviations and Acronyms   ANOVA = analysis of variance   CFR = coronary flow reserve   LAD = left anterior descending coronary artery

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