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Contrast-enhanced transthoracic second harmonic echo doppler with adenosine

A noninvasive, rapid and effective method for coronary flow reserve assessment

^a Division of Cardiology, University of Cagliari, Cagliari, Italy

View larger version (177K): [in a new window]   Figure 1 Artist’s drawing illustrating transducer beam orientations to the left anterior descending coronary artery (LAD) (A, B, F, H) with the corresponding echocardiographic images of LAD color flow (C–E, G, I): in particular panels A and B indicate tomographic plane orientation for attaining, respectively, a parasternal short- and long-axis view of the distal LAD. Color flow visualized with this approach is represented in panels C, D (short-axis views of color flow) and E (long-axis view of color flow); panel F indicates the transducer orientation for a more apical approach still for the distal LAD (color flow visualized with this approach is represented in panel G); panel H is the tomographic orientation for the visualization of the midtract of the LAD (color flow visualized with this approach is represented in panel I). AO = aorta; CF = color flow; LA = left atrium; LV = left ventricle; MV = mitral valve; RA = right atrium; RV = right ventricle; RVOT = right ventricular outflow tract; SVC = superior vena cava.

View larger version (107K): [in a new window]   Figure 2 Coronary flow reserve (CFR) evaluated in a patient with a normal left anterior descending coronary artery (upper series of panels) and with obstructive stenosis (lower series of panels). The first and second panel of each of two series illustrate spectral Doppler signal at baseline before and after contrast enhancement, respectively; the third panel represents the contrast-enhanced signal during hyperemia.

View larger version (79K): [in a new window]   Figure 3 Color Doppler flow mapping in the distal left anterior descending coronary artery (LAD) before (upper panel) and after contrast enhancement using, respectively, fundamental mode (midpanel) and harmonic mode (lower panel). A modified two-chamber view has been obtained. Before contrast infusion (upper panel) faint LAD flow (score 2) is detected by color Doppler in fundamental mode in the anterior groove area (epicardial side of the left ventricular anterior wall). After contrast infusion, blooming and flashing blur color flow Doppler signal from the LAD when fundamental Doppler is used (midpanel); switching to second harmonic (lower panel) color-coded blood flow in the LAD is clearly depicted (indicated by arrows). Enhancement of color Doppler signal in the left ventricular cavity is also evident. LV = left ventricle.

View larger version (18K): [in a new window]   Figure 4 Individual value bar graph indicating CFR for group I (LAD stenosis 0% to <40%), group II (LAD stenosis 40 to 75%) and group III (LAD stenosis >75%). Mean (± 1 SD) values are also shown. Abbreviations as in Figure 3.