Simultaneous assessment of wall motion and coronary flow velocity in the left anterior descending coronary artery during dipyridamole stress echocardiography.
OBJECTIVE
This study was designed to assess the feasibility and clinical meaning of simultaneous assessment of wall motion and coronary flow velocity (CFV) reserve in the left anterior descending coronary artery (LAD) by transthoracic approach for detecting LAD stenosis during dipyridamole stress echocardiography.


BACKGROUND
Coronary flow reserve plays an important role, which can be evaluated by transthoracic Doppler echocardiography during vasodilator stress.


METHODS
Dipyridamole stress test was performed in 110 patients with known or suspected coronary artery disease. CFV in the distal LAD was obtained at baseline and after dipyridamole infusion, and wall motion was also assessed up to the administration of atropine, if required. All patients underwent quantitative coronary angiography within 2 days of the stress test, and significant LAD stenosis was defined as > 50% stenosis.


RESULTS
The success rate of both measurements was 92%. CFV reserve < 2 had a higher sensitivity (94% vs 72%, P <.01) and a lower specificity (65% vs 95%, P <.01) than wall-motion assessment for detecting significant LAD stenosis, and diagnostic accuracy between 2 methods was comparable (81% vs 82%). A total of 69 patients (73%) showed concordant results of the 2 methods, and diagnostic accuracy for detecting significant LAD stenosis was high (94%) in this subset of patients.


CONCLUSIONS
The simultaneous assessment of CFV and wall motion was feasible in the majority of cases during dipyridamole stress echocardiography. Although diagnostic accuracy between the 2 tests was comparable, concordant results of the 2 methods provided accurate diagnosis in detecting significant LAD stenosis.
Department of Cardiovascular Medicine, Cardiovascular Center, Iizuka Hospital, Japan. notomiy@ccf.org
Yuichi
Y
Nohtomi
Masaaki
M
Takeuchi
Kazushige
K
Nagasawa
Ken-ichi
K
Arimura
Kenji
K
Miyata
Kouichi
K
Kuwata
Tohru
T
Yamawaki
Shoichi
S
Kondo
Akira
A
Yamada
Shuichi
S
Okamatsu
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology / Q000502:physiology*; D004176:Dipyridamole; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole