Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study

Abstract

Backgroundthe clinical decision making could be difficult in patients with borderline lesions (visually assessed stenosis severity of 30 to 50%) of the left main coronary artery (LM). The aim of the study was to evaluate the relationship between transthoracic Doppler (TTDE) peak diastolic flow velocity (PDV) and intravascular ultrasound (IVUS) measurements in the assessment of angiographically borderline LM lesions.Methods27 patients (mean age 64 ± 8 years, 21 males) with borderline LM stenosis referred for IVUS examination were included in the study. We performed standard IVUS with minimal lumen area (MLA) and plaque burden (PB) measurement and routine quantitative coronary angiography (QCA) with diameter stenosis (%DS) and area stenosis (%AS) assessment in all. During TTDE, resting PDV was measured in the LM.Resultsinterpretable Doppler signal could be obtained in 24 patients (88% feasibility); therefore these patients entered the final analysis. MLA was 7.1 ± 2.7 mm2. TTDE measured PDV correlated significantly with IVUS-derived MLA (r = -0.46, p < 0.05) and plaque burden (r = 0.51, p < 0.05). Using a velocity cut-off of 112 cm/sec TTDE showed a 92% sensitivity and 62% specificity to identify IVUS-significant (MLA < 6 mm2) LM stenosis.ConclusionIn angiographically borderline LM disease, resting PDV from transthoracic echocardiography is increased in presence of increased plaque burden by IVUS. TTDE evaluation might be a useful adjunct to other invasive and non-invasive methods in the assessment of borderline LM lesions. Further, large scale studies are needed to establish the exact cut-off value of PDV for routine clinical application.

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“…IVUS is generally used to visualize atherosclerotic plaque, particularly in the coronary arteries, to interrogate the lumen‐intima interface and identify areas of under‐diagnosed plaque burden . Current clinical uses of IVUS include evaluating complex lesions pre‐angioplasty and assessing adequacy of stent deployment.…”

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“…According to the results of coronary angiography, the patients were divided into three groups. Control group: patients with non‐obstructive coronary atherosclerosis, defined as angiography results showing absence of narrowing of coronary arteries, or left main stenosis <30%, or single‐vessel (left anterior descending artery, left circumflex artery, or right coronary artery) stenosis besides left main trunk <50%; single‐ or two‐vessel disease group: stenoses in one or two of the epicardial coronary arteries ≥50%; left main or three‐vessel disease group: stenosis in the left main artery ≥30%, or stenoses in all three epicardial coronary arteries ≥50% (Ragosta et al., 2006; Ruzsa et al., 2011).…”