title: Does Doppler echography have a diagnostic role in patency assessment of internal thoracic artery grafts?
abstract: The amount of literature published over the past decade comparing coronary angiography with transthoracic Doppler echocardiography assessment of internal thoracic artery graft patency after CABG is substantial. There has been no review of the available literature, and conflicting reports of diagnostic accuracy have prevented routine use of transthoracic Doppler in graft patency assessment. Thus, this article reviews the available literature on diagnostic accuracy of transthoracic Doppler echocardiography of coronary bypass grafts. Relevant studies were identified and meta-analysis of diagnostic accuracy was performed. Study quality was assessed. Quantitative data synthesis included calculation of sensitivity, specificity, summary receiver operating characteristic curve analysis, pooled analysis and meta-regression of accuracy against study quality, publication date, angina, probe frequency and diagnostic criteria. Twenty studies of 929 patients produced 26 results included for analysis. Grafts were not visualized in 93 (10%) patients. Pooled sensitivity (85%) and specificity (94%) and diagnostic odds ratio (100.7) were high. SROC analysis showed an area under the curve of 0.96. Heterogeneity of results was due to variations in diagnostic criteria and study size. Subgroup analysis showed best performance in patients with postoperative angina (p = 0.014). Study quality did not affect results. Diastolic fraction less than 0.5 (sensitivity 89%, specificity 94%) was shown to be the best criterion for prediction of stenosis. Performance was lower using peak diastolic to systolic velocity ratio less than 1 (sensitivity 85%, specificity 86%). Transthoracic Doppler echography is effective in first-line assessment of left internal thoracic artery graft patency. It shows high specificity, prevents invasive investigations and improves in patients with postoperative angina. TDE is best used in combination with other non-invasive tests due to its inability to visualize the graft. The potential for use in postoperative coronary bypass patients is high.
authors.affiliation: Academic Surgical Unit, Department of Cardiothoracic Surgery, Imperial College of Science Technology and Medicine, St Mary's Hospital, London W2 1NY, UK.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Jones
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
authors.forename: Vitali
authors.initials: V
authors.lastname: Malinovski
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
authors.forename: Ahmed
authors.initials: A
authors.lastname: Haq
authors.forename: John
authors.initials: J
authors.lastname: Kokotsakis
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014654:Vascular Patency