Feasibility of Measuring Coronary Flow Velocity and Reserve in the Left Anterior Descending Coronary Artery by Transthoracic Doppler Echocardiography in a Relatively Obese American Population

Takeuchi, Masaaki; Lodato, Joseph A.; Furlong, T R N Kathy; Lang, Roberto M.; Yoshikawa, Junichi

doi:10.1111/j.0742-2822.2005.04004.x

Cited by 34 publications

(23 citation statements)

References 17 publications

(41 reference statements)

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“…Myocardial contrast echo suffers from excessive variability (35). Doppler echocardiography has gained some acceptance in the literature (36) as well as reproducibility in populations with known CAD,(37). However, this technique also suffers from variability in patient anatomy and the inability to evaluate multiple coronary vascular territories.…”

Section: Current Challenges In Cmd Treatment Researchmentioning

confidence: 99%

Coronary Microvascular Dysfunction, Microvascular Angina, and Treatment Strategies

Marinescu

Löffler

Ouellette

et al. 2015

JACC: Cardiovascular Imaging

233

206

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Angina without coronary artery disease (CAD) has substantial morbidity and is present in 10–30% of patients undergoing angiography. Coronary microvascular dysfunction (CMD) is present in 50–65% of these patients. The optimal treatment of this cohort is undefined. We performed a systematic review to evaluate treatment strategies for objectively defined CMD in the absence of CAD. We included studies assessing therapy in human subjects with angina and coronary flow reserve (CFR) or myocardial perfusion reserve (MPR) <2.5 by positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), dilution methods, or intracoronary Doppler in the absence of coronary artery stenosis ≥50% or structural heart disease. Only 8 articles met strict inclusion criteria. The articles were heterogeneous, using different treatments, end-points, and definitions of CMD. Small sample sizes severely limit the power of these studies, with an average of 11 patients per analysis. Studies evaluating, sildenafil, quinapril, estrogen, and transcutaneous electrical nerve stimulation (TENS) application demonstrated benefits in their respective endpoints. No benefit was found with L-arginine, doxazosin, pravastatin, and diltiazem. Our systematic review highlights that there is little data to support therapies for CMD. We assess the data meeting rigorous inclusion criteria and review the related but excluded literature. We additionally describe the next steps needed to address this research gap, including a standardized definition of CMD, routine assessment of CMD in studies of chest pain without obstructive CAD, and specific therapy assessment in the population with confirmed CMD.

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Section: Current Challenges In Cmd Treatment Researchmentioning

confidence: 99%

Coronary Microvascular Dysfunction, Microvascular Angina, and Treatment Strategies

Marinescu

Löffler

Ouellette

et al. 2015

JACC: Cardiovascular Imaging

233

206

View full text Add to dashboard Cite

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“…We did not use contrast agents which could have improved the visualization of the LAD coronary artery [31]. …”

Section: Study Limitationsmentioning

confidence: 99%

Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography

Forte¹,

Rousse²,

Lowenstein³

2011

Cardiovasc Ultrasound

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BackgroundThe determination of coronary flow reserve (CFR) is an essential concept at the moment of decision-making in ischemic heart disease. There are several direct and indirect tests to evaluate this parameter. In this sense, dobutamine stress echocardiography is one of the pharmacological method most commonly used worldwide. It has been previously demonstrated that CFR can be determined by this technique. Despite our wide experience with dobutamine stress echocardiography, we ignored the necessary heart rate to consider sufficient the test for the analysis of CFR. For this reason, our main goal was to determine the velocity of coronary flow in each stage of dobutamine stress echocardiography and the heart rate value necessary to double the baseline values of coronary flow velocity in the territory of the left anterior descending (LAD) coronary artery.MethodsA total of 33 consecutive patients were analyzed. The patients included had low risk for coronary artery disease. All the participants underwent dobutamine stress echocardiography and coronary artery flow velocity was evaluated in the distal segment of LAD coronary artery using transthoracic color-Doppler echocardiography.ResultsThe feasibility of determining CFR in the territory of the LAD during dobutamine stress echocardiography was high: 31/33 patients (94%). Mean CFR was 2.67 at de end of dobutamine test.There was an excellent concordance between delta HR (difference between baseline HR and maximum HR) and the increase in the CFR (correlation coefficient 0.84). In this sense, we found that when HR increased by 50 beats, CFR was ≥ 2 (CI 93-99.2%). In addition, 96.4% of patients reached a CFR ≥ 2 (IC 91.1 - 99%) at 75% of their predicted maximum heart rate.ConclusionsWe found that the feasibility of dobutamine stress echocardiography to determine CFR in the territory of the LAD coronary artery was high. In this study, it was necessary to achieve a difference of 50 bpm from baseline HR or at least 75% of the maximum predicted heart rate to consider sufficient the test for the analysis of CFR.

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“…Тем более, что определение «новых», по-являющихся зон нарушения сократимости во время обыч-ной стресс-ЭхоКГ, часто затруднено на фоне уже имею-щихся изменений у пациентов с перенесенными ИМ. Вы-явленные в настоящем исследовании параметры коронар-ного кровотока, как минимум, не уступают в прогности-ческой значимости рутинной стресс-ЭхоКГ, при этом яв-ляются количественными высоковоспроизводимыми ве-личинами, что было показано в предыдущих работах [11,18,19].…”

Section: Discussionunclassified

Prognostic value of non-invasive assessment of left anterior descending coronary artery blood flow during exercise test in patients with previous myocardial infarction

Zagatina¹,

Zhuravskaya²

2016

Kardiol. serdechno-sosud. khir.

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ИшемИческая болезнь сердцаИнфаркт миокарда (ИМ) является одним из часто встречаемых и опасных проявлений ишемической болез-ни сердца (ИБС) в России [1] и других странах мира [2,3]. Пациенты с перенесенными ИМ имеют повышенный риск дальнейших неблагоприятных исходов -более 5% в год, что в 6-7 раз выше по сравнению с популяционными данными людей того же возраста [4,5]. Определение так-тики ведения этих пациентов предполагает выявление прогностических факторов неблагоприятного исхода для своевременного направления данных больных на опера-ции реваскуляризации с целью возможного предотвраще-ния сердечно-сосудистой смерти. Одним из основных ме-тодов для стратификации риска пациентов с ИБС, в том числе с перенесенными ИМ, являются нагрузочные тесты Цель исследования -определение прогностического значения параметров коронарного кровотока, измеренного допплерографией во время тестов с физической нагрузкой у пациентов с перенесенными ранее инфарктами миокарда. Методы. В исследование были включены 297 больных, наблюдение за исходами которых продолжалось в течение 3 лет. До окончания исследования связь с 18 пациентами была потеряна. В окончательный анализ вошли данные 279 больных (94% исходной выборки). Результаты. у 194 человек (69,5%) во время стресс-эхокардиографии выявлены признаки ишемии. Депрессия сегмента ST-T более 1 мм в двух и более отведениях во время теста регистрировалась у 31% -60 человек с положительным (ишемическим) результатом, а также у 31% -26 человек с отрицательным (неишемическим) тестом. среднее значение диастолической скорости кровотока в срединном сегменте ПМЖА в основной группе до нагрузки было равно 36±16 см/с, скорость на пике физической нагрузки равнялась 60±28 см/с, разница данных скоростей у пациентов была в среднем 24±25 см/с, расчетный коронарный резерв в данной артерии -1,7±0,7. Выводы. Величина коронарного резерва ПМЖА, а также разница скоростей на пике и до нагрузки в ПМЖА коррелируют с неблагоприятными исходами в трехлетний срок после проведения измерений (r ≈ -0,42, р <0,0000001; r ≈ -0,40, р <0,0000001, соответственно). Ключевые слова: стресс-эхокардиография, коронарный резерв, стресс-эхо с физической нагрузкой, визуализация коронарных артерий, прогноз стресс-эхо. Prognostic value of non-invasive left anterior coronary artery flow during exercise test in patients with previuos myocardial infarctionA.V. ZAgAtinA, n.t. ZhurAVskAyA Cardiology center «Medika», st. Petersburg, russia Aim -to define the prognostic value of coronary flow measured by Doppler-sonography during exercise tests in patients with previous myocardial infarction. Material and methods. the study included 297 patients. Outcomes were followed-up within 3 years. the communication with 18 patients was lost before study's end. the final analysis included 279 (94%) patients. Results. 194 (69,5%) persons had ischemic signs during stress echocardiography. st-segment depression over 1 mm during exercise test was detected in two or more leads in 31% including 60 cases of positive (ischemic) result and 26 patients with negative (n...

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Feasibility of Measuring Coronary Flow Velocity and Reserve in the Left Anterior Descending Coronary Artery by Transthoracic Doppler Echocardiography in a Relatively Obese American Population

Cited by 34 publications

References 17 publications

Coronary Microvascular Dysfunction, Microvascular Angina, and Treatment Strategies

Coronary Microvascular Dysfunction, Microvascular Angina, and Treatment Strategies

Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography

Prognostic value of non-invasive assessment of left anterior descending coronary artery blood flow during exercise test in patients with previous myocardial infarction

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