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CLINICAL STUDY: ULTRASOUND CORONARY IMAGING

Detection of coronary restenosis aftercoronary angioplasty by contrast-enhanced transthoracic echocardiographic Doppler assessment of coronary flow velocity reserve

Massimo Ruscazio, MD^*,*, Roberta Montisci, MD^*, Paolo Colonna, MD^*, Carlo Caiati, MD^*, Lijun Chen, MD^*, Giorgio Lai, MD^*, Mauro Cadeddu, MD^*, Raimondo Pirisi, MD^* and Sabino Iliceto, MD, FACC

^* Department of Cardiovascular and Neurological Science, University of Cagliari, Italy
Division of Cardiology, Department of Internal Medicine, University of Padua, Italy

Manuscript received May 8, 2001; revised manuscript received May 9, 2002, accepted May 24, 2002.

^* Reprint requests and correspondence: Dr. Massimo Ruscazio, S. Giovanni di Dio Hospital, via Ospedale 46, 09124, Cagliari, Italy.
ruscard{at}unica.it

OBJECTIVES: This study sought to evaluate the diagnostic potential of contrast-enhanced transthoracic echocardiography (CE-TTE) during adenosine infusion, a noninvasive method for evaluating coronary flow reserve (CFR), in detecting restenosis after successful percutaneous transluminal coronary angioplasty (PTCA).

BACKGROUND: Restenosis is the most important limitation of PTCA, and CFR can be impaired in patients with angiographically documented significant coronary stenosis.

METHODS: We performed 6 ± 2 months of follow-up of 53 patients after successful elective PTCA in the left anterior descending coronary artery (LAD). Coronary angiography was performed at the end of the planned follow-up period or even before, if clinically indicated. Thus, of the 53 patients, a total of 63 angiographic studies were performed; CE-TTE assessment of CFR was achieved before each of the 63 angiographic studies.

RESULTS: Coronary angiography revealed the presence of restenosis (defined as >50% stenosis at a previous PTCA site) in 32 angiographic examinations (group A) and no coronary restenosis in the remaining 31 examinations (group B). Coronary flow reserve was significantly reduced in group A compared with group B (1.65 ± 0.5 vs. 3.17 ± 0.8, p 0.001). A noninvasive CFR value 2 was 93% specific and 78% sensitive for detecting significant restenosis, with positive and negative diagnostic accuracies of 92% and 80%, respectively.

CONCLUSIONS: Noninvasive CFR assessment by CE-TTE is an accurate method of monitoring significant restenosis in the LAD when following up patients submitted to elective PTCA.

Abbreviations and Acronyms   CE-TTE   contrast-enhanced transthoracic echocardiography   CFR   coronary flow reserve   DFW   Doppler flow wire   LAD   left anterior descending coronary artery   MRI   magnetic resonance imaging   PTCA   percutaneous transluminal coronary angioplasty

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