Assessment of intermediate stenosis in the left anterior descending coronary artery with contrast-enhanced transthoracic Doppler echocardiography |
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Authors: | Okayama Hideki Sumimoto Takumi Hiasa Go Nishimura Kazuhisa Morioka Norikatsu Yamamoto Kouzo Kawada Hiroyuki |
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Institution: | Department of Carediology, Kitaishikai Hospital, 2632-3 Tokunomori, Ozu, Ehime 795-0061, Japan. hiokayam@sea.plala.or.jp |
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Abstract: | BACKGROUND: Visual or quantitative assessment of coronary angiography may not exactly predict the physiological significance of intermediate (40-70%) coronary stenosis. Coronary flow reserve is a well-established marker of the functional significance of coronary stenosis. OBJECTIVES: The aim of this study was to compare the coronary flow velocity reserve (CFVR) using contrast-enhanced transthoracic Doppler echocardiography (CE-TTDE) with thallium-201 imaging in assessment of intermediate lesions in the left anterior descending coronary artery (LAD). METHODS: A consecutive series of 50 patients with intermediate stenosis in the LAD underwent pharmacological stress thallium-201 imaging and CFVR measured by CE-TTDE. RESULTS: CFVR could be measured in 49 of 50 patients by the present method. A CFVR <2.0 predicted the presence of a stress thallium defect in 12 of 14 patients (agreement=90%, kappa=0.76, P < 0.001). The sensitivity and specificity of CFVR for stress thallium-201 results were 86 and 91%, respectively. In contrast, significant stenosis (>50% by diameter) showed fair agreement for stress thallium defects (agreement=59%, kappa=0.28, P < 0.05). CONCLUSIONS: In the evaluation of intermediate lesions in the LAD, CFVR as assessed by CE-TTDE could accurately predict the presence of ischemia on stress thallium imaging, whereas angiographic stenosis did not yield reliable results. |
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