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Noninvasive Assessment of Coronary
Flow Reserve by Transthoracic Doppler
Echocardiography in a General Referral
Population: Experience on 957 Patients

Lowenstein, Jorge; Presti, Cecilia; Tiano, Cristian

Sanatorio Mitre, Buenos Aires, Argentina

Coronary flow reserve (CFR) is an important index to assess the coronary function; the possibility of its determination by a total noninvasive method will make its utilization more frequent. The aim of the study was to evaluate the feasibility and value of measuring CFR with transthoracic Doppler echocardiography (TTE ) in the daily practice.

Methods: In 957 patients (pts) (608 male; mean age 65.2 ± 19 years) the diastolic coronary flow velocity was continuously monitored by pulsed- wave Doppler at the distal region of the left anterior descending artery (LAD), at rest and during the hyperemic phase induced by 0.84 mg /kg of Dipyridamole (Dip) for 4 min (775 pts ), 0.14mg/kg/min of Adenosine (Adeno ) for 2 min (104 pts ) or by the infusion up to 40 ug/kg/min of Dobutamine (Dobu) (78 pts). The test was performed in 312 pts with angina in 115 pts with atypical chest pain , in 141 pts during the post infarction period , in 30 pts with dilated miocardiopathy in 60 pts after CABG, in 74 pts following PTCA , in 60 pts for preoperative risk evaluation, and in 165 pts for others reasons. The CFR was calculated as the ratio between the maximal and the basal velocity ; these data were correlated with the angiograms performed the week after the TTE in 204 pts (Dip 162 pts , Adeno 27 pts, Dobu 15 pts ).

Results: A clearly legible Doppler signal was obtained with Dip: 715 / 775 pts, with Adeno: 94 /104 pts and with Dobu 55 /78 pts; the feasibility result was 92 %, 90 % and 71% respectively. The results of group A (95 pts with LAD < 70 % stenosis) were compared with group B (109 pts with LAD ³ 70% stenosis): Table 1

A CFR >2 was registered in 70/95 pts with non significant LAD stenosis (specificity: 74%) and a CFR< 2 was determined in 72/81 pts with critical LAD stenosis (sensitivity of 88.8 %).

Conclusions: CFR by TTE has a high feasibility, especially with vasodilator drugs and proves very useful in the noninvasive assessment of functionally significant disease in the territory of the LAD.



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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
Dr. Raúl Bretal
Scientific Committee
Dr. Armando Pacher
Technical Committee - CETIFAC

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