Doppler derived coronary flow reserve during dobutamine stress echocardiography further improves detection of myocardial ischemia☆

Abstract

Background: The coronary flow velocity (CFV) has been used to estimate coronary flow reserve (CFR) during dobutamine stress echocardiography (DSE). However, the relationship of the CFR to myocardial wall thickening (WT) has not been investigated. Objectives: The aims of this study were: (1) to assess the feasibility of obtaining systolic and diastolic CFV and thus CFR during DSE and (2) to assess the relation between CFR and stress induced WT. Methods: Distal left anterior descending CFV was recorded by transthoracic Doppler echocardiography during DSE. Systolic and diastolic velocities were measured at rest, low and peak dobutamine doses, simultaneously, WT of distal anteroseptal segment was assessed by 2D-guided M-mode. The CFV and CFR of patients with normal WT defined as thickening of O50% (group 1) at peak stress were compared to that of patients with abnormal WT (group 2). Results: A total of 67 patients, 34 females and 33 males (mean age of 66.5 G 14.5 years) were studied. The feasibility of assessing the CFR was 97% from peak diastolic velocity, 91% from diastolic time velocity integral, 91% from peak systolic velocity, and 90% from systolic time velocity integral. Contrast agent was used in 6 patients (7%) to obtain the CFV. Twenty-five of 67 patients demonstrated abnormal * Conflict of interest and financial disclosure: none.Abbreviations: CFV, coronary flow velocity; CFR, coronary flow reserve; WT, wall thickening; PDV, peak diastolic velocity; DTVI, diastolic time velocity integral; PSV, peak systolic velocity; STVI, systolic time velocity integral.

Incremental Value of Pulse Wave Velocity in the Determination of Coronary Microcirculatory Dysfunction in Never-treated Patients With Essential Hypertension

“…13 The feasibility of recording the V TI -V d , V d , and V s at rest and after adenosine was >98% for all indices in our study cohort and is 98% for both V d and V TI -V d and 95% for V s for various populations in our laboratory in accordance with previous studies. 28 Previous studies have defined a CFR <2 (ref. 11,23,24,30) as significantly abnormal and between 2 and 2.5 as borderline normal.…”

“…CFR was calculated as the ratio of hyperemic to resting diastolic velocity time integral as this index better corresponds to blood volume flow rate when vessel cross-sectional area remains unchanged according to standard Doppler methodology. [26][27][28][29] Measurements from three cardiac cycles were averaged. Inter-and intra-observer variability of these measurements in our laboratory were ~5 and 2% for V d , 6 and 4% for V s , 4 and 2% for V TI -V d , in accordance with previously published studies.…”

Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives

“…CFR was calculated as the ratio of hyperemic to resting diastolic velocity time integral according to standard Doppler methodology. 8,16 Inter-and intra-observer variability of these measurements in our laboratory were B4 and 2%, as previously published. 8 The mean CFR value of our cohort (o2.5) was used for subgroup analysis after previously published cutoff values for impaired CFR in hypertensives.…”

Assessment of Coronary Flow During Stress Testing: Does it Add Diagnostic and Prognostic Value?

“…In a study performed by Ahmari et al [38], the feasibility of assessing the CFR from peak diastolic velocity was strikingly high (97%). The authors, from the Mayo Clinic, concluded that CFR assessment during DOBSE correlated well with wall thickening and detected ischemia early before the development of wall motion abnormality, emphasizing the importance of determining CFR in this type of study; however, they do not perform this study in daily practice.…”