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

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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Diagnostic value of coronary artery assessment by transthoracic ecocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.382 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Kamenskikh ◽

A Zagatina ◽

N Zhuravskaya ◽

D Shmatov

Keyword(s):

Coronary Artery ◽

Flow Velocity ◽

Coronary Flow ◽

Diagnostic Value ◽

Proximal Segment ◽

Local Flow ◽

Coronary Flow Velocity ◽

Flow Acceleration ◽

Funding Sources ◽

Independent Expert

Abstract Funding Acknowledgements Type of funding sources: None. Several recent studies have reported the opportunity for diagnosing significant narrowing of the coronary arteries during echocardiography using the local flow acceleration in the stenosis. However, there is a discrepancy between the cut-off coronary flow velocity (CFV) values in the literature. The aim of our study was to define the cut-off value of CFV for coronary artery stenosis more than 50%. Methods In a single-center study, we evaluated 100 patients (53 men, 62 ± 11 y.o.) who underwent echocardiography with scans for CFV in 3 segments of left coronary artery. Coronary angiography was performed by an independent expert specialist, blind other data. Results Two hundred and fifty-three segments (84%) of proximal left coronary were feasible for assessment. There was a significant correlation between coronary flow velocity and percent of stenosis in the corresponding segments, R = 0.52; p < 0.0000001, (figure). The cut-off value of 67 cm/s had sensitivity 69%, specificity 89%, accuracy 79%, р<0.0004 for left main narrowing more than 50% by angiography. The cut-off value of 70 cm/s in proximal segment of left anterior descending had sensitivity 62%, specificity 88%, accuracy 82%, р<0.0001, the cut-off value of 50 cm/s in proximal segment of left circumflex had sensitivity 73%, specificity 88%, accuracy 81%, р<0.003 for stenoses of more than 50%. Conclusion There is a significant positive correlation between coronary flow velocity by echocardiography and degree of narrowing by angiography.

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Prognostic value of non-invasive coronary artery flow velocity assessment in elderly patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.097 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Kalinina ◽

A Zagatina ◽

N Zhuravskaya ◽

D Shmatov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Elderly Patients ◽

Flow Velocity ◽

Coronary Arteries ◽

Coronary Flow ◽

Prognostic Value ◽

Area Under Curve ◽

Left Coronary Artery ◽

Maximal Velocity

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a high prevalence of coronary artery disease (CAD) in the elderly population. However, symptoms of CAD are often non-specific. Dyspnoe, non-anginal pains are among the main symptoms in older patients. Exercise tests are of limited feasibility in these patients, due to neuro-muscular weakness, physical deconditioning, and orthopaedic limitations. Pharmacological tests often are contraindicated in a substantial percentage of elderly patients. Some recent studies indicate using local flow acceleration during routine echocardiography has prognostic potential for coronary artery assessments without stress testing. The aim of the study was to define the prognostic value of coronary artery ultrasound assessment in patients ≥75 years old. Methods This is a prospective cohort study. Patients ≥ 75 years old who underwent routine echocardiography with additional scans for coronary arteries over a period of 24 months were included in the study. The study group consisted of 80 patients aged 75-90 years (56 women; mean age 79 ± 4). Initial exams were performed for other reasons, primarily for arterial hypertension. Fifteen patients had known CAD. Death, non-fatal myocardial infarction (MI), and revascularization were defined as major adverse cardiac events (MACE). All patients were followed up with at a median of 32 months. Results There were 34 patients with high local velocities in the left coronary artery. Eight deaths, two non-fatal myocardial infarctions occurred, and 13 revascularizations were performed. With a ROC analysis, a coronary flow velocity >110 cm/s was the best predictor for risk of death (area under curve 0.84 [95% CI 0.74–0.92]; sensitivity 75%; specificity 88%). Only the maximal velocity in proximal left-sided coronary arteries was independently associated with death (HR 1.03, 95% CI 1.01; 1.05; p < 0.002), or death/MI (HR 1.03, 95% CI 1.01; 1.04; p < 0.0001). The cut-off value of 66 cm/s was a predictor of all MACE (area under curve 0.87 [95% CI 0.77–0.94]; sensitivity 80%; specificity 86%). Any causes of death or MI occurred more frequently in patients with velocities of >66 cm/s (27% vs. 2%; p < 0.002). The rates of MACE were 58.0% vs. 2%; p < 0.0000001, respectively. Conclusion The analysis of coronary flow in the left coronary artery during echocardiography can be used as a predictor of outcomes in elderly patients. Maximal velocities in proximal left-sided coronary arteries is independently associated with further death or myocardial infarction.

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