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Melotti E, Belmonte M, Gigante C, Mallia V, Mushtaq S, Conte E, Neglia D, Pontone G, Collet C, Sonck J, Grancini L, Bartorelli AL, Andreini D. The Role of Multimodality Imaging for Percutaneous Coronary Intervention in Patients With Chronic Total Occlusions. Front Cardiovasc Med 2022; 9:823091. [PMID: 35586657 PMCID: PMC9108201 DOI: 10.3389/fcvm.2022.823091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPercutaneous coronary intervention (PCI) of Chronic total occlusions (CTOs) has been traditionally considered a challenging procedure, with a lower success rate and a higher incidence of complications compared to non-CTO-PCI. An accurate and comprehensive evaluation of potential candidates for CTO-PCI is of great importance. Indeed, assessment of myocardial viability, left ventricular function, individual risk profile and coronary lesion complexity as well as detection of inducible ischemia are key information that should be integrated for a shared treatment decision and interventional strategy planning. In this regard, multimodality imaging can provide combined data that can be very useful for the decision-making algorithm and for planning percutaneous CTO recanalization.AimsThe purpose of this article is to appraise the value and limitations of several non-invasive imaging tools to provide relevant information about the anatomical characteristics and functional impact of CTOs that may be useful for the pre-procedural assessment and follow-up of candidates for CTO-PCI. They include echocardiography, coronary computed tomography angiography (CCTA), nuclear imaging, and cardiac magnetic resonance (CMR). As an example, CCTA can accurately delineate CTO location and length, distal coronary bed, vessel tortuosity and calcifications that can predict PCI success, whereas stress CMR, nuclear imaging and stress-CT can provide functional evaluation in terms of myocardial ischemia and viability and perfusion defect extension.
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Affiliation(s)
- Eleonora Melotti
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Marta Belmonte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlo Gigante
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Vincenzo Mallia
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, Pisa, Italy
- Istituto di Scienze della Vita Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luca Grancini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- *Correspondence: Daniele Andreini
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Allahwala UK, Brilakis ES, Kiat H, Ayesa S, Nour D, Ward M, Lo S, Weaver JC, Bhindi R. The indications and utility of adjunctive imaging modalities for chronic total occlusion (CTO) intervention. J Nucl Cardiol 2021; 28:2597-2608. [PMID: 33025478 DOI: 10.1007/s12350-020-02381-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 01/09/2023]
Abstract
Coronary chronic total occlusions (CTO) are common in patients undergoing coronary angiography, yet the optimal management strategy remains uncertain, with conflicting results from randomized trials. Appropriate patient selection and careful periprocedural planning are imperative for successful patient management. We review the role of adjunctive imaging modalities including myocardial perfusion imaging (MPI), cardiac magnetic resonance imaging (CMR), echocardiography and computed tomography coronary angiography (CTCA) in myocardial ischemic quantification, myocardial viability assessment, as well as procedural planning for CTO revascularization. An appreciation of the value, indications and limitations of these modalities prior to planned intervention are essential for optimal management.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia.
| | | | - Hosen Kiat
- Faculty of Medicine and Health Sciences, Macquarie University, Marsfield, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Sally Ayesa
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
- Department of Nuclear Medicine, Prince of Wales Hospital, Sydney, Australia
| | - Daniel Nour
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | - James C Weaver
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
- Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
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Carbone A, D'Andrea A, Sperlongano S, Tagliamonte E, Mandoli GE, Santoro C, Evola V, Bandera F, Morrone D, Malagoli A, D'Ascenzi F, Bossone E, Cameli M. Echocardiographic assessment of coronary microvascular dysfunction: Basic concepts, technical aspects, and clinical settings. Echocardiography 2021; 38:993-1001. [PMID: 33948990 PMCID: PMC8252466 DOI: 10.1111/echo.15059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 01/06/2023] Open
Abstract
Coronary flow reserve is the capacity of the coronary circulation to augment the blood flow in response an increase in myocardial metabolic demands and has a powerful prognostic significance in different clinical situations. It might assess with invasive and noninvasive technique. Transthoracic echocardiography Doppler is an emerging diagnostic technique, noninvasive, highly feasible, safe for patient and physician, without radiation, and able to detect macrovascular and microvascular anomalies in the coronary circulation. This review aims to describe the benefit and limits of echocardiographic assessment of coronary flow reserve.
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Affiliation(s)
- Andreina Carbone
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Simona Sperlongano
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Ercole Tagliamonte
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Evola
- Department of Clinical and Experimental Medicine, University of Palermo, Palermo, Italy
| | - Francesco Bandera
- Heart Failure Unit, Chair of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Health Science, University of Milan, Milan, Italy
| | - Doralisa Morrone
- Cardiothoracic Department, Cisanello Hospital, University of Pisa, Pisa, Italy
| | | | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Dobric M, Beleslin B, Tesic M, Djordjevic Dikic A, Stojkovic S, Giga V, Tomasevic M, Jovanovic I, Petrovic O, Rakocevic J, Boskovic N, Sobic Saranovic D, Stankovic G, Vukcevic V, Orlic D, Simic D, Nedeljkovic MA, Aleksandric S, Juricic S, Ostojic M. Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium. Cardiovasc Ultrasound 2020; 18:29. [PMID: 32693812 PMCID: PMC7374915 DOI: 10.1186/s12947-020-00211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment, but data on coronary hemodynamic changes in relation to myocardial function are limited. We assessed changes in coronary flow velocity reserve (CFVR) by echocardiography in collateral donor and recanalized artery following successful opening of coronary CTO. Methods Our study enrolled 31 patients (60 ± 9 years; 22 male) with CTO and viable myocardium by SPECT scheduled for percutaneous coronary intervention (PCI). Non-invasive CFVR was measured in collateral donor artery before PCI, 24 h and 6 months post-PCI, and 24 h and 6 months in recanalized artery following successful PCI of CTO. Results Collateral donor artery showed significant increase in CFVR 24 h after CTO recanalization compared to pre-PCI values (2.30 ± 0.49 vs. 2.71 ± 0.45, p = 0.005), which remained unchanged after 6-months (2.68 ± 0.24). Baseline blood flow velocity of the collateral donor artery significantly decreased 24 h post-PCI compared to pre-PCI (0.28 ± 0.06 vs. 0.24 ± 0.04 m/s), and remained similar after 6 months, with no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24 h and 6 months post-PCI. CFVR of the recanalized coronary artery 24 h post-PCI was 2.55 ± 0.35, and remained similar 6 months later (2.62 ± 0.26, p = NS). Conclusions In patients with viable myocardium, prompt and significant CFVR increase in both recanalized and collateral donor artery, was observed within 24 h after successful recanalization of CTO artery, which maintained constant during the 6 months. Trial registration ClinicalTrials.gov (Number NCT04060615).
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Affiliation(s)
- Milan Dobric
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia. .,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia.
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Ana Djordjevic Dikic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Sinisa Stojkovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Miloje Tomasevic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozara Markovica Street, Kragujevac, 34000, Serbia
| | - Ivana Jovanovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Olga Petrovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia
| | - Jelena Rakocevic
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Nikola Boskovic
- Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Dragana Sobic Saranovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Goran Stankovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Vladan Vukcevic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Dejan Orlic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Dragan Simic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Milan A Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Srdjan Aleksandric
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
| | - Stefan Juricic
- Cardiology Clinic, Clinical Center of Serbia, 26 Visegradska Street, Belgrade, 11000, Serbia
| | - Miodrag Ostojic
- Faculty of Medicine, University of Belgrade, 6 Dr Subotica Street, Belgrade, 11000, Serbia
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5
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Bergami M, Amaduzzi PL, Bugiardini R. Takotsubo Syndrome: Does the Octopus Trap Hide Dangers? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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6
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Choi JH, Kim EK, Kim SM, Song YB, Hahn JY, Choi SH, Gwon HC, Lee SH, Choe YH, Oh JK. Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography. Circ Cardiovasc Imaging 2014; 7:482-90. [PMID: 24700691 DOI: 10.1161/circimaging.113.001637] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Coronary collateral flow is an alternative source of myocardial perfusion in patients with totally occluded coronary arteries. Clinical evaluation of collateral flow has been limited by the need of invasive measurements. We investigated whether noninvasive coronary computed tomographic angiography can evaluate the angiographic extent of coronary collateral flow. METHODS AND RESULTS We enrolled 325 coronary computed tomographic angiography cases with angiographically confirmed chronic total occlusion (median age, 63 years; men 83%). Transluminal attenuation gradient (TAG), which reflects the kinetics of contrast media in coronary artery, of an entire artery as well as of a distal vessel was assessed to evaluate the flow in entire vessel and distal vessel. TAGs were validated against visually assessed angiographic collateral connection and Rentrop grading. TAG of an entire artery increased consistently according to the angiographic extent of collateral flow (P<0.001). Well-developed collaterals, defined by highest collateral connection and Rentrop grades (n=103), could be predicted by TAG of an entire artery (cutoff, ≥-7.6 Hounsfield units/10 mm; c-statistics, 0.72; sensitivity, 65%; specificity, 73%; positive predictive value, 52%; negative predictive value, 82%). TAG of a distal vessel could discriminate the antegrade (n=143) and retrograde (n=182) flows in distal artery (cutoff, 0.0 Hounsfield unit/10 mm; c-statistics, 0.88; sensitivity, 78%; specificity, 85%; positive predictive value, 87%; negative predictive value, 75%). CONCLUSIONS TAG, an intracoronary attenuation-based analysis of coronary computed tomographic angiography, moderately reflected the functional extent and direction of collateral flow.
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Affiliation(s)
- Jin-Ho Choi
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.).
| | - Eun Kyoung Kim
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sung Mok Kim
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Young Bin Song
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Joo-Yong Hahn
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Seung Hyuk Choi
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Hyeon-Cheol Gwon
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sang Hoon Lee
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Yeon Hyeon Choe
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Jae K Oh
- From the Departments of Medicine (J.-H.C., E.K.K., Y.B.S., J-Y.H., S.H.C., H.-C.G., S.H.L., J.K.O.), Emergency Medicine (J.-H.C.), and Radiology (S.M.K., Y.H.C.), Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
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Vegsundvåg J, Holte E, Wiseth R, Hegbom K, Hole T. Coronary artery occlusions diagnosed by transthoracic Doppler. Cardiovasc Ultrasound 2014; 12:12. [PMID: 24628779 PMCID: PMC3995529 DOI: 10.1186/1476-7120-12-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/05/2014] [Indexed: 11/17/2022] Open
Abstract
Background Our aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow. Methods A total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied using transthoracic Doppler echocardiography. Results Anterograde peak diastolic flow velocities (pDV) in septal perforating branches were higher in patients with angiographic occluded contralateral artery compared with corresponding velocities in patients without significant disease in the contralateral artery (0.80 ± 0.31 m/sec versus 0.37 ± 0.13 m/sec, p < 0.001). Receiver operating characteristic curve showed pDV ≥ 0.57 m/sec to be the optimal cutoff value to identify occluded contralateral artery, with a sensitivity of 79% and a specificity of 69%. Demonstration of at least one positive parameter (retrograde flow in main coronary arteries, reversed flow in septal perforating and left circumflex marginal branches, pDV ≥ 0.57 m/sec, or demonstration of other epicardial or intramyocardial collaterals) indicating collateral flow to an occluded main coronary artery had sensitivity, specificity, positive and negative predictive value of 89%, 94%, 63%, and 99%, respectively, for detection of a coronary occlusion. With this combined use of several parameters, 25 of 28 coronary occlusions were identified. Conclusions By investigating several parameters indicating collateral flow, we were able to identify most of the main coronary occlusions in the patient cohort. Furthermore, our study demonstrated that coronary artery occlusions may result in complex and diverging coronary pathophysiology depending on which coronary artery segment is occluded and the extent of accompanying coronary artery disease. Trial registration ClinicalTrials.gov number
NTC00281346.
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8
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Mladenovic Z, Djordjevic-Dikic A, Tavciovski D, Angelkov AR, Jovic Z, Djuric P. The additive diagnostic role of coronary flow reserve in noninvasive evaluation of coronary stenosis on left descending artery previously detected by multislice computed tomography. Echocardiography 2012; 30:338-44. [PMID: 23134228 DOI: 10.1111/echo.12041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Multislice computed coronary angiography (MSCT) provides valuable morphological information about coronary artery disease, but precise quantification of coronary stenosis remains difficult. Transthoracic color Doppler echocardiography (TDE) gives a new insight into the functional significance of coronary luminal narrowing. We have tried to assess the additive value of coronary flow reserve (CFR) determined by TDE over MSCT in prediction of a significant stenosis on the left anterior descending artery (LAD) using the invasive coronary angiography (ICA) as a reference method. METHODS This prospective study included 63 patients in stable cardiac status with previously detected atherosclerotic lesions on LAD by MSCT. CFR assessment by TDE with adenosine infusion was obtained to all patients (feasibility was 96.92%). CFR was determined as ratio between the peak diastolic flow velocity during adenosine infusion and at basal condition, a cutoff value indicating significant stenosis was <2. ICA was preformed to all patients 24-48 hours after CFR. RESULTS MSCT had sensitivity of 86.36%, specificity 53.66%, positive predictive value 50.00%, negative predictive value 88.00%, and diagnostic accuracy of 65.07% in detection of significant LAD stenosis. CFR had sensitivity 81.81%, specificity 97.06%, positive predictive value 94.74%, negative predictive value 89.19%, and diagnostic accuracy of 91.07%. When the results of both methods were agreed diagnostic accuracy was improved to 92.72%. CONCLUSION Additional assessment of CFR by TDE increase diagnostic accuracy of MSCT angiography in detection of significant coronary artery lesions.
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9
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Sharif D, Sharif-Rasslan A, Shahla C, Abinader EG. Detection of severe left anterior descending coronary artery stenosis by transthoracic evaluation of resting coronary flow velocity dynamics. Heart Int 2010; 5:e10. [PMID: 21977295 PMCID: PMC3184686 DOI: 10.4081/hi.2010.e10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 06/23/2010] [Accepted: 08/03/2010] [Indexed: 11/23/2022] Open
Abstract
In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances in echocardiography have made non-invasive sampling of velocities in the left anterior descending coronary artery (LAD) possible. The aim of our study was to evaluate feasibility and capability of transthoracic Doppler to detect severe stenosis of the LAD. The study population consisted of 42 subjects with suspected coronary artery disease scheduled for coronary angiography. All had complete transthoracic echocardiography and Doppler sampling of LAD velocities. Quantitative coronary angiography was performed within 24 hours of the echocardiogram. Correlations between LAD velocity profile, measurements and calculations, and the angiographic results were performed. Six subjects had LAD occlusion, 10 had severe (>80% diameter) LAD stenosis, and 26 had normal or non-occlusive LAD disease. In all six subjects with LAD occlusion, distal LAD velocities were not detectable, while in the other 36 subjects, LAD velocities were recorded indicating the vessels were patent. In the 10 subjects with severe LAD stenosis, the diastolic/systolic velocity ratio was <1.5, while in those with non-significant LAD disease, the diastolic/systolic velocity ratio was >1.5 (P<0.005). Diastolic LAD flow was 21.8±13 mL/min in the presence of severe stenosis as compared to 48.5±20 mL/min in subjects without severe stenosis (P<0.0013). LAD velocities had high sensitivity and specificity for the prediction of severe angiographic stenosis. Thus transthoracic Doppler measurement of LAD velocities is feasible and can predict the presence of severe LAD stenosis or occlusion.
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Affiliation(s)
- Dawod Sharif
- Department of Cardiology, Bnai Zion Medical Center, Haifa
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Pizzuto F, Voci P, Bartolomucci F, Puddu PE, Strippoli G, Broglia L, Rossi P. Usefulness of coronary flow reserve measured by echocardiography to improve the identification of significant left anterior descending coronary artery stenosis assessed by multidetector computed tomography. Am J Cardiol 2009; 104:657-64. [PMID: 19699341 DOI: 10.1016/j.amjcard.2009.04.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 04/27/2009] [Accepted: 04/27/2009] [Indexed: 11/16/2022]
Abstract
Multidetector computed tomography (MDCT) detects coronary artery disease. However, an overestimation of coronary artery stenosis and artifacts can prevent accurate identification of significant coronary narrowing. The combination of MDCT with coronary flow reserve (CFR), the hyperemic/baseline peak flow velocity ratio, measured by transthoracic Doppler echocardiography might be helpful. We studied 144 consecutive patients with CFR and quantitative coronary angiography, obtained using both MDCT and invasive coronary angiography (reference method). It was hypothesized that the CFR might provide an incremental value to MDCT in detecting significant (> or =70%) left anterior descending (LAD) coronary artery stenosis. A CFR cutoff of <2 was used to discriminate significant stenosis. CFR was feasible in 141 (98%) of 144 patients, and MDCT was feasible in 131 (91%) of 144 patients (p <0.02). In a univariate model, the prediction of significant LAD stenosis was slightly, but significantly (p <0.0001), better with CFR (sensitivity 90%, specificity 96%, positive predictive value 84%, negative predictive value 97%, and diagnostic accuracy 94%, chi-square = 97.5) than with MDCT (sensitivity 80%, specificity 93%, positive predictive value 71%, negative predictive value 95%, diagnostic accuracy 90%, chi-square = 63.2). When the findings from transthoracic Doppler echocardiography and MDCT agreed, the diagnostic accuracy increased (96%; chi-square = 86.1, p <0.0001). In a multivariate prediction of significant LAD stenosis using a logistic neural network, CFR overshadowed MDCT, and the area under the receiver operating curve was 0.99. Of the 13 patients missed by MDCT, the diagnostic accuracy of transthoracic Doppler echocardiography to predict significant LAD stenosis was 100%. Thus, CFR could improve the diagnostic accuracy of MDCT to detect significant LAD stenosis.
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Boshchenko AA, Vrublevsky AV, Karpov RS. Transthoracic echocardiography in the detection of chronic total coronary artery occlusion. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 10:62-8. [PMID: 18490275 DOI: 10.1093/ejechocard/jen159] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The aim of our study was to detect chronic total occlusion of the left anterior descending coronary artery (LAD), circumflex coronary artery (Cx), and right coronary artery (RCA) using transthoracic echocardiography (TTE) in 110 consecutive patients who underwent coronary angiography for investigation of angina. METHODS AND RESULTS Coronary blood flow direction was assessed in the epicardial collaterals [distal LAD (dLAD), obtuse marginal branches and right posterior descending artery (PDA)] and intramyocardial collaterals [LAD septal branch (SB LAD) and RCA septal branch (SB RCA)]. The sensitivity and specificity of retrograde flow for identification of the occluded LAD by TTE in the dLAD only were 78 and 96%, respectively, and those in both dLAD and SB LAD were 89 and 96%, respectively. The retrograde SB LAD flow detects proximal LAD occlusion with 88% sensitivity and 75% specificity. The sensitivity and specificity of retrograde flow for identification of the occluded RCA by TTE in the PDA only were 79 and 97%, respectively, and those in both PDA and SB RCA were 89 and 97%, respectively. The retrograde SB RCA flow does not allow us to differentiate between proximal and non-proximal RCA occlusion. Transthoracic echocardiography is not a method for diagnosing Cx occlusions as the success in visualizing the Cx epicardial collaterals was achieved in 31% of cases only. CONCLUSION TTE is a sensitive and highly specific non-invasive method for diagnosis of LAD and RCA occlusions, based on the detection of the coronary blood flow direction in the epicardial and intramyocardial collaterals.
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Affiliation(s)
- Alla A Boshchenko
- Department of Atherosclerosis and Coronary Artery Disease, Cardiology Research Institute, Russian Academy of Medical Sciences, Siberian Branch, Kievskaya Street, 111a, 634012 Tomsk, Russia.
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Meimoun P, Tribouilloy C. Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: a magic tool for the real world. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 9:449-57. [PMID: 18296409 DOI: 10.1093/ejechocard/jen004] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transthoracic Doppler echocardiography, introduced in the echo-lab in recent last years, to measure coronary flow and coronary flow reserve, is a very attractive tool, totally non-invasive, and easily available at bedside. This review summarizes the actual possibilities of this tool, its multiple potential clinical applications and diagnostic insights, and its arising prognosis value, in coronary artery disease as in various settings affecting the coronary microcirculation.
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Affiliation(s)
- Patrick Meimoun
- Department of Cardiology and Intensive Care Unit, Compiègne Hospital, 8 rue Henri Adnot, 60200 Compiègne, France
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