Multiparametric carotid and cardiac ultrasound compared with clinical risk scores for the prediction of angiographic coronary artery disease

Moreo, Antonella; Gaibazzi, Nicola; Faggiano, Pompilio; Mohammed, M.; Carerj, Scipione; Mureddu, Gianfrancesco; Pigazzani, Filippo; Muiesan, Lorenza; Salvetti, Massimo; Cesana, Francesca; Faden, Giacomo; Facchetti, Rita; Giannattasio, Cristina; Rigo, Fausto

doi:10.1097/hjh.0000000000000543

Cited by 19 publications

(7 citation statements)

References 42 publications

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“…Усовершенствование ультразвукового оборудования за последние 10 лет позволило качественно изменить возможность исследования магистральных коронарных артерий при помощи серийного трансторакального датчика при выполнении рутинной эхокардиографии [3][4][5]. Проводились работы по сопоставлению данных ультразвукового исследования коронарных артерий с результатами коронароангиографии, в которых была доказана значимая корреляция между высокими скоростями коронарного кровотока и наличием значительных стенозов коронарных артерий, выявленных при проведении коронароангиографии [6,13].…”

Section: Discussionunclassified

The Role of Myocardial Revascularization in the Survival of Patients With Altered Coronary Blood Flow Detected by Transthoracic Ultrasound

Каменских

Zagatina

Zhuravskaya

et al. 2019

SMJ

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Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

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Section: Discussionunclassified

The Role of Myocardial Revascularization in the Survival of Patients With Altered Coronary Blood Flow Detected by Transthoracic Ultrasound

Каменских

Zagatina

Zhuravskaya

et al. 2019

SMJ

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“…A persistent flow velocity of ≥ 0.70 m/s was defined as the threshold for a significant stenosis, based on previous experience and recent scientific data (9).…”

Section: Methodsmentioning

confidence: 99%

“…However, these studies were performed on cohorts which only included patients scheduled for coronary angiography. One study demonstrated an excellent statistical relationship between coronary flow velocity of 0.7 m/s and the presence of significant lesions of the left anterior descending coronary artery (LAD) (9). However, there is a lack of studies which compare aliased coronary flow velocity at rest with the functional abnormalities of the left ventricle during exercise stress echocardiography.…”

Section: Introductionmentioning

confidence: 99%

Transthoracic Coronary Flow Data at Rest Predict High-Risk Stress Tests

Zagatina¹,

Zhuravskaya²,

Vareldzhyan³

et al. 2017

Acta Radiol

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Background Several recent studies have reported the opportunity to diagnose significant narrowing of the coronary arteries without stress testing using local flow acceleration. Purpose To define how often patients with increased coronary flow velocities at rest (≥ 0.70 m/s) have a positive exercise echocardiography test. Material and Methods A total of 150 patients scheduled for exercise echocardiography were studied using transthoracic Doppler echocardiography in order to assess coronary artery flow velocity before exercise. Pulsed wave Doppler registered blood flow velocity placed on the color signal. The maximal diastolic velocity of coronary flow was measured. Results Of participants, 16% had a velocity of more than 0.70 m/s in the left main/proximal left anterior/proximal left circumflex arteries (LM/pLAD). A significant correlation was observed between the value of the maximal velocity in LM/pLAD and the ejection fraction at the peak of exercise ( r ≈ -0.39, P < 0.0001); between the value of the maximal velocity in LM/pLAD and index of wall motion abnormalities (IWMA) at the peak of exercise ( r ≈ 0.44, P < 0.0001); and between the value of the maximal velocity in LM/pLAD and dIWMA ( r ≈ 0.41, P < 0.0001). Afterwards, severe ischemia in stress echocardiography tests was observed in this group. The average IWMA of these tests was found to be 2.3. Sixty-two angiograms were available for comparison with Doppler data. Conclusion There is a significant correlation between the value of the maximal velocity in LM/pLAD/pLCx at rest and the severity of wall motion abnormalities during exercise tests.

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“…Other variables, such as the ultrasound cardiac calcium score may help in the prediction of CAD, as calcium in the valves and other cardiac or vascular sites is associated with the presence of CAD. [36][37][38][39][40][41][42] In conclusion, regarding the first 'diagnostic' point, this is a win for CCTA over stress-echocardiography, in particular thanks to better sensitivity both for obstructive and subclinical CAD when CCTA is directly compared with standard stress-echocardiography (based on wall motion behaviour only); when stress-echocardiography is performed with the newest add-ons, such as measurement of CFVR-LAD, contrast perfusion imaging or other variables, its diagnostic sensitivity clearly improves (sometimes at expense of lower specificity), but the overall accuracy never reaches the numbers of CCTA, which implies direct anatomic imaging of coronary arteries. [43][44][45] Clinical case of a patient presenting with suspected coronary artery disease undergoing stressechocardiography first Figure 1 demonstrates normal wall motion behaviour at rest and Fig.…”

Section: Diagnosing Coronary Artery Diseasementioning

confidence: 99%

Stress-echocardiography or coronary computed tomography in suspected chronic coronary syndrome after the 2019 European Guidelines? A practical guide

Gaibazzi

Tuttolomondo

Guaricci

et al. 2021

Journal of Cardiovascular Medicine

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Stress-echocardiography can rightly be considered one of the champions of cardiac functional imaging, thanks to its real-time imaging, high temporal resolution, high safety and very low cost. When stress-echocardiography is performed at top technical quality, hence taking advantage of ultrasound contrast media for endocardial border delineation at least for suboptimal cases, subjectivity is minimized, and with the routine use of coronary flow reserve measurement (left anterior descending coronary artery, stress/rest ratio reduced or normal, i.e. <>2.0) diagnostic sensitivity is strengthened.The true competitor of any type of functional imaging, stress-echocardiography included, is nowadays coronary computed tomography angiography, which is instead a diagnostic method directly, noninvasively assessing coronary anatomy, apparently the holy grail for any cardiologist. The new 2019 Guidelines on chronic coronary syndrome of the European Society of Cardiology change the existing landscape and clinical practice, while they probably cannot clarify which type of test, functional or anatomic, should be first chosen in different clinical scenarios of suspected chronic coronary syndrome. We review the existing data and the authors' personal view in order to assess how functional stress-echocardiography compares with coronary computed tomography angiography regarding three main aspects: diagnosis of coronary artery disease, guidance of therapy (coronary revascularization versus medical therapy) and risk stratification.

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Multiparametric carotid and cardiac ultrasound compared with clinical risk scores for the prediction of angiographic coronary artery disease

Abstract: In Echo-Lab, Rome, Italy, the integrated cardiovascular ultrasound study is feasible in a high percentage of patients. The combination of three parameters, that is, score of calcium, cIMT, and LAD velocity, has incremental predictive value for obstructive CAD.

Cited by 19 publications

References 42 publications

The Role of Myocardial Revascularization in the Survival of Patients With Altered Coronary Blood Flow Detected by Transthoracic Ultrasound

The Role of Myocardial Revascularization in the Survival of Patients With Altered Coronary Blood Flow Detected by Transthoracic Ultrasound

Transthoracic Coronary Flow Data at Rest Predict High-Risk Stress Tests

Stress-echocardiography or coronary computed tomography in suspected chronic coronary syndrome after the 2019 European Guidelines? A practical guide

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