From the Division of Cardiology, Kobe (Japan) General Hospital.
Correspondence to Takeshi Hozumi, MD, Division of Cardiology, Kobe General Hospital, 4–6 Minatojima-nakamachi, Chuo-ku, Kobe 650, Japan. E-mail jse{at}warp.or.jp
Background—Coronary
flow reserve has been considered an important diagnostic
index of the functional significance of coronary artery
stenosis. With Doppler technique, it has been assessed as
the ratio of hyperemic to basal coronary flow velocity
(coronary flow velocity reserve [CFVR]) by invasive or
semiinvasive methods with a Doppler catheter, a Doppler guide
wire, and a transesophageal Doppler
echocardiographic probe. Recent technological
advancement in transthoracic Doppler
echocardiography (TTDE) provides measurement of
coronary flow velocity in the distal portion of the left
anterior descending coronary artery (LAD) and may be useful in
the noninvasive CFVR measurement. The purpose of this study was to
evaluate the value of CFVR determined by TTDE for the assessment of
significant LAD stenosis.
Methods and Results—We studied 36 patients who underwent
coronary angiography for the assessment of coronary
artery disease. The study population consisted of 12 patients with
significant LAD stenosis (group A) and 24 patients without
significant LAD stenosis (group B). With TTDE, coronary
flow velocities in the distal LAD were recorded at rest and during
hyperemia induced by intravenous infusion of
adenosine (0.14 mg · kg-1 ·
min-1) under the guidance of color Doppler flow
mapping. Adequate spectral Doppler recordings of
coronary flow in the distal LAD for the assessment of CFVR were
obtained in 34 of 36 study patients (94%). The peak and mean
diastolic coronary flow velocities at baseline did
not differ between groups A and B (23.6±10.3 versus 22.9±6.6 cm/s and
16.4±8.6 versus 14.5±4.0 cm/s, respectively). However, the peak and
mean coronary flow velocities during hyperemia in group
A were significantly smaller than those in group B (35.6±16.3 versus
54.2±16.3 cm/s and 24.7±13.1 versus 37.9±13.0 cm/s, respectively;
P<.01). There were significant differences in CFVR
obtained from peak and mean diastolic velocity between
groups A and B (1.5±0.2 versus 2.4±0.4 and 1.5±0.2 versus 2.6±0.4,
respectively; P<.001). A CFVR from peak
diastolic velocity <2.0 had a sensitivity of 92% and a
specificity of 82% for the presence of significant LAD
stenosis. A CFVR from mean diastolic velocity <2.0
had a sensitivity of 92% and a specificity of 86% for the presence of
significant LAD stenosis.
Conclusions—CFVR determined by TTDE is useful in the noninvasive
assessment of significant stenotic lesion in the LAD.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Noninvasive Assessment of Significant Left Anterior Descending Coronary Artery Stenosis by Coronary Flow Velocity Reserve With Transthoracic Color Doppler Echocardiography
Key Words: blood flow • coronary disease • echocardiography
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