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Validation of a new noninvasive method (contrast-enhanced transthoracic second harmonic echo Doppler) for the evaluation of coronary flow reserve

Comparison with intracoronary Doppler flow wire

^a Institute of Cardiology, University of Cagliari, Cagliari, Italy
^* Division of Cardiology, "S. Maugeri" Foundation, IRCCS Medical Center of Rehabilitation, Cassano Murge, Italy

View larger version (53K): [in a new window]   Figure 1 Color Doppler flow mapping in the distal LAD before (A, upper panel) and after contrast enhancement (A, lower panel). A modified 2-chamber view has been obtained: Artist’s rendering of this tomographic plane orientation to LAD is illustrated in (B). Before enhancement (A, upper panel) LAD flow is barely detected (score 2) by color Doppler in fundamental mode in the anterior groove area (epicardial side of the left ventricular anterior wall marked by arrows). After enhancement (contrast infusion in combination with color Doppler in second harmonic mode) (A, lower panel) color-coded blood flow in the LAD is clearly depicted (indicated by arrows). LAD = left anterior descending coronary artery; LV = left ventricle.

View larger version (111K): [in a new window]   Figure 2 Spectral Doppler tracing by sampling in the distal LAD before (upper left panel) and after contrast enhancement (upper mid-panel) at rest. Before contrast infusion, spectral Doppler signal is scarcely detectable (score 2). After contrast enhancement, a biphasic flow with a prevalent diastolic component is clearly depicted (score 3). Abbreviations as in Figure 1.

View larger version (79K): [in a new window]   Figure 3 Example of a patient with a normal CFR. Enhanced transthoracic spectral tracing is shown at the top (at the baseline, left upper panel, and during hyperemia, right upper panel). The corresponding velocity curves obtained by IDFW are shown at the bottom. Velocities and CFRs are almost identical by the two methods. The shapes of the curves are also similar. CFR = coronary flow reserve; IDFW = intracoronary Doppler flow wire.

View larger version (79K): [in a new window]   Figure 4 Example of a patient with an abnormal CFR. Enhanced transthoracic (top) and intracoronary Doppler (bottom) are shown. A blunted response is depicted by both methods. Angiography showed a subocclusive proximal LAD stenosis. Abbreviations as in Figures 1 and 3.

View larger version (11K): [in a new window]   Figure 5 Scattergram (left panel) showing the relation between CFR obtained by two methods: enhanced transthoracic Doppler (x-axis) and IDFW (y-axis). Lines of equality (dotted line) and correlation (continuous line) are shown. Plot of the difference (right panel) between the CFR obtained by the two above-mentioned methods against their mean. Dotted lines represent boundaries of mean ± 2 SD. E-TTE = enhanced transthoracic Doppler; IDFW = intracoronary Doppler flow wire; Diff = difference. Other abbreviations as in Figure 3.

View larger version (11K): [in a new window]   Figure 6 Scattergram (left panel) showing the relation between CFRs obtained by the same method (transthoracic Doppler) 1 h apart. Lines of equality (dotted line) and correlation (continuous line) are shown. Plot of the difference (right panel) between the two CFR measurements against their mean is shown. Dotted lines represent boundaries of mean ± 2 SD. Abbreviations as in Figure 3.