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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

View larger version (59K): [in a new window]   Figure 1 Color Doppler flow mapping of modified low parasternal long-axis view (top left) and spectral Doppler tracing (top right) in distal left anterior descending coronary artery (LAD) after contrast enhancement. Color-coded blood flow in the LAD is clearly seen (arrow). Spectral Doppler shows biphasic coronary flow with predominance of diastolic component. Middle and lower panels show an example of another patient with normal response. After infusion of dobutamine, coronary flow velocity gradually increased. Baseline diastolic mean velocity was 17.2 cm/s, and flow velocity increased to 54.4 cm/s after injection of atropine; thus, coronary flow velocity ratio peak is 3.16. Speed of recording 100 mm/s, velocity scale 80 cm/s. LV = left ventricle.

View larger version (51K): [in a new window]   Figure 2 Example of a patient with stress-induced wall motion abnormality in the left anterior descending coronary artery territory. Increase in coronary flow velocity is almost lost during dobutamine infusion. Coronary flow velocity ratio peak is 1.08. Note diastolic-systolic flow velocity ratio is inverted during higher dose of dobutamine infusion. Velocity scale 60 cm/s.

View larger version (19K): [in a new window]   Figure 3 Individual value bar graph representing coronary flow velocity (CFV) ratio at 20 µg/kg per min of dobutamine infusion (CFV ratio 20) and CFV ratio at peak stress (CFV ratio peak) for group I (development of stress-induced wall motion abnormality at intermediate dose), group II (wall motion abnormality at peak stress) and group III (normal response). Best cutoff line (dotted line) and mean value ± SD are also shown.