Evaluation of Left Anterior Descending Coronary Artery Stenosis of Intermediate Severity Using Transthoracic Coronary Flow Reserve and Dobutamine Stress Echocardiography

Meimoun, Patrick; Benali, Tahar; Sayah, Smaïn; Luycx-Bore, A.; Boulanger, J.; Zemir, H.; Tribouilloy, Christophe

doi:10.1016/j.echo.2005.05.011

Cited by 32 publications

(17 citation statements)

References 35 publications

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“…Contrary to the results of some clinical studies showing an increased basal peak diastolic velocity after MI, we found a decreased value in the MI+ mice. The plausible explanations for this discrepancy are as follows: (1) We investigated the MI+ mice without sufficient time to develop compensatory hypertrophy and collateral vessels after surgery, whereas patients commonly had a long history of cardiovascular diseases 25 . (2) In the clinic, transthoracic echocardiography was performed after successful revascularization by percutaneous coronary intervention, 26 , 27 different from the permanent left anterior descending artery ligation in our study.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Estimation of Infarct Size in a Mouse Model of Myocardial Infarction by Echocardiographic Coronary Perfusion

You

Jia

et al. 2012

Journal of Ultrasound in Medicine

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Section: Discussionmentioning

confidence: 99%

Noninvasive Estimation of Infarct Size in a Mouse Model of Myocardial Infarction by Echocardiographic Coronary Perfusion

You

Jia

et al. 2012

Journal of Ultrasound in Medicine

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“…Coronary artery stenosis decreases microvascular flow reserve in the stenotic bed [12]. Evaluation of coronary flow reserve was applied during stress echocardiography with dobutamine solely or with the addition of adenosine before the stress for the assessment of coronary artery disease [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Coronary Flow Reserve of the Non-Ischemia Related Coronary Artery During Dobutamine Stress Echocardiography

et al. 2011

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BackgroundIncorporation of analysis of coronary velocities in stress studies adds diagnostic value to both clinical variables and dobutamine echocardiography. Micorcirculatory abnormalities may precede obstructive corornary disease. Therefore the aim of this study was to assess Doppler derived coronary velocity and flow of the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE) in patients without LAD-related ischemia.MethodsSixty nine patients with chest pain underwent DSE studies to evaluate myocardial ischemia. All had trans-thoracic Doppler interrogation of the distal LAD before and just after termination of the DSE. Coronary velocity reserves (CFR) were calculated as the ratios of post-DSE/baseline diastolic velocities. Volumetric flow in the distal LAD was calculated from the diameter of LAD color jet and velocity integral. Volumetric flow reserve was calculated as the ratio of post-DSE baseline LAD flows.ResultsAt rest all subjects had left ventricular wall motion score index (WMSI) = 1, while in 28, wall motion abnormality appeared in non-LAD territory with WMSI = 1.17 ± 0.08. Peak diastolic velocity after DSE increased form 28.5 ± 13.6 to 52.4 ± 23.7 cm/sec, P = 9.5 × 10-11, and velocity-CFR was 2.08 ± 0.7. Diastolic LAD flow increased from 36.5 ± 23.8 to 75.75 ± 48.7 mL/min, P = 1.21 × 10-7 and volumetric-CFR was 2.6 ± 2.8. Peak diastolic velocity-CFR in patients without LV wall motion abnormality was 2.4 ± 0.7 while in those with motion abnormality 1.77 ± 0.56, P = 0.00008. Flow-derived LAD-CFR was 3.3 ± 3.7 in those without compared to 1.88 ± 0.57 in patients with wall motion abnormality, P < 0.05.ConclusionLAD velocity and flow reserves are reduced in patients with remote myocardial ischemia, which may indicate early atherosclerotic involvement.

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“…For the wall motion scoring of each segment, the following patterns were observed: normal = 1; hypokinesia = 2; akinesia = 3; or dyskinesia = 4. For the calculation of the segmental wall motion score index (SWMSI), the points obtained were divided by 16 1,5,6,10,12 .…”

Section: Methodsmentioning

confidence: 99%

“…The CFVR was obtained by dividing DPV (mean of three peaks) found during DSE by the baseline DPV (mean of three peaks) recorded at rest 6-8,10,12,15,20,22 .…”

Section: Methodsmentioning

confidence: 99%

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

Abreu¹,

Lima²,

Diógenes³

et al. 2013

Arquivos Brasileiros De Cardiologia

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Background A coronary flow velocity reserve (CFVR) ≥ 2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease. Objective To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE). Methods 100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of β-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was < 2 and, in group II, CFVR was ≥ 2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values < 0.05 were considered statistically significant. Results At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53±31 vs. 45±32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9±9.3 vs. 61.2±10.8 years; p=0.04), had lower ejection fraction (61±10 vs. 66±6%; p=0.005), higher DPV-Rest (36.81±08 vs. 25.63 ± 06cm/s; p<0.0001) and lower CFVR (1.67 ± 0.24 vs. 2.53 ± 0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40±16 vs. 64.23±16cm/s; p=0.42). β-blocker discontinuation was associated with a 4-fold higher chance of a CFVR < 2 (OR= 4; 95% CI [1.171-13.63], p=0.027). Conclusion DPV-Rest was the main parameter to determine an adequate CFVR. β-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology.

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Evaluation of Left Anterior Descending Coronary Artery Stenosis of Intermediate Severity Using Transthoracic Coronary Flow Reserve and Dobutamine Stress Echocardiography

Cited by 32 publications

References 35 publications

Noninvasive Estimation of Infarct Size in a Mouse Model of Myocardial Infarction by Echocardiographic Coronary Perfusion

Noninvasive Estimation of Infarct Size in a Mouse Model of Myocardial Infarction by Echocardiographic Coronary Perfusion

Coronary Flow Reserve of the Non-Ischemia Related Coronary Artery During Dobutamine Stress Echocardiography

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

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