A Novel Technique to Detect Total Occlusion in the Right Coronary Artery Using Retrograde Flow by Transthoracic Doppler Echocardiography

Otsuka, Ryo; Watanabe, Hiroyuki; Hirata, Kumiko; Tokai, Kotaro; Muro, Takashi; Hozumi, Takeshi; Yoshiyama, Minoru; Yoshikawa, Junichi

doi:10.1016/j.echo.2004.11.018

Cited by 19 publications

(10 citation statements)

References 32 publications

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“…Because of longer distance to the echocardiographic probe, the Cx, CxMbs, RCA/PDA, and septal branches from PDA were more difficult to visualize than the LAD and its septal branches. The use of ultrasound contrast agent might have improved the feasibility of demonstrating collateral and retrograde flow [14,15]. Because of limited clinical experience in patients with ACS, we chose not to use ultrasound contrast when planning this study.…”

Section: Discussionmentioning

confidence: 99%

Coronary artery occlusions diagnosed by transthoracic Doppler

Vegsundvåg

Holte

Wiseth

et al. 2014

Cardiovasc Ultrasound

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BackgroundOur aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow.MethodsA total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied using transthoracic Doppler echocardiography.ResultsAnterograde peak diastolic flow velocities (pDV) in septal perforating branches were higher in patients with angiographic occluded contralateral artery compared with corresponding velocities in patients without significant disease in the contralateral artery (0.80 ± 0.31 m/sec versus 0.37 ± 0.13 m/sec, p < 0.001). Receiver operating characteristic curve showed pDV ≥ 0.57 m/sec to be the optimal cutoff value to identify occluded contralateral artery, with a sensitivity of 79% and a specificity of 69%. Demonstration of at least one positive parameter (retrograde flow in main coronary arteries, reversed flow in septal perforating and left circumflex marginal branches, pDV ≥ 0.57 m/sec, or demonstration of other epicardial or intramyocardial collaterals) indicating collateral flow to an occluded main coronary artery had sensitivity, specificity, positive and negative predictive value of 89%, 94%, 63%, and 99%, respectively, for detection of a coronary occlusion. With this combined use of several parameters, 25 of 28 coronary occlusions were identified.ConclusionsBy investigating several parameters indicating collateral flow, we were able to identify most of the main coronary occlusions in the patient cohort. Furthermore, our study demonstrated that coronary artery occlusions may result in complex and diverging coronary pathophysiology depending on which coronary artery segment is occluded and the extent of accompanying coronary artery disease.Trial registrationClinicalTrials.gov number NTC00281346.

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Section: Discussionmentioning

confidence: 99%

Coronary artery occlusions diagnosed by transthoracic Doppler

Vegsundvåg

Holte

Wiseth

et al. 2014

Cardiovasc Ultrasound

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“…Angiography data demonstrate that in LAD and RCA occlusions, besides collateral flow distal to the occluded region through the connections on the epicardial surface, 63-86% of patients have intramyocardial collateral channels lying usually in the interventricular septum. According to these findings an additional examination of the retrograde flow in the septal branches of the LAD and RCA has demonstrated the increase of TTE sensitivity in the CTO detection from 88 to 96% for the LAD and from 67 to 80% for the RCA (Otsuka et al, 2005, Saraste et al, 2005. According to our data (Boshchenko et al, 2009), the sensitivity and specificity of retrograde flow for identification of the occluded LAD by TTE in distal LAD alone were 77% and 97%, and those in both distal LAD and septal branches of the LAD -85% and 97%, respectively.…”

mentioning

confidence: 80%

“…Watanabe et al, 2001, proposed the inversion of the coronary blood flow in the epicardial collateral vessels on color Doppler map to be a main ultrasound sign of CTO. It has been established that retrograde flow in distal LAD is a good marker of LAD occlusion with 88% sensitivity and 100% specificity and retrograde flow in the PDA is a good marker of RCA occlusion with 67% sensitivity and 100% specificity (Otsuka et al, 2005). But Pizzuto et al, 2006, doubted such a high sensitivity of TTE in the detection of LAD occlusion having revealed a retrograde flow in distal LAD in only 43% of patients with CTO and normal anterograde flow in more than half patients (55%).…”

mentioning

confidence: 99%

Transthoracic Echocardiography in the Assessment of Coronary Arteries

Boshchenko¹,

Vrublevsky²,

Карпов³

2011

Coronary Angiography - Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease

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“…Before adenosine triphosphate administration, we diagnosed one of three vessels as having chronic total occlusion due to retrograde 41 and collateral 42,43 flow by Doppler color flow mapping. On the other hand, Doppler signals of the remaining two vessels could not be detected.…”

Section: Limitationsmentioning

confidence: 99%