title: Evaluation of blood flow reserve in left anterior descending coronary artery territory by quantitative myocardial contrast and Doppler echocardiography.
abstract: We sought to compare the feasibility and accuracy of myocardial blood flow reserve (MBFR) measured by quantitative real-time myocardial contrast echocardiography with those of coronary flow velocity reserve (CFVR) obtained by transthoracic Doppler echocardiography for detecting left anterior descending coronary artery (LAD) stenosis. We studied 71 patients who underwent adenosine stress contrast echocardiography, transthoracic Doppler echocardiography, and quantitative coronary angiography within 1 month. An index of myocardial blood flow (A x beta) was determined by quantification of peak plateau acoustic intensity (A) and microbubble replenishment velocity (beta) by contrast echocardiography. Feasibilities of qualitative analysis of myocardial perfusion, and CFVR and MBFR measurements were 98%, 83%, and 94%, respectively. Patients with LAD stenosis had lower CFVR (1.1 +/- 0.4 vs 2.7 +/- 0.8, P < .001), MBFR (1.2 +/- 0.5 vs 2.5 +/- 0.8, P < .001), and beta reserve (1.1 +/- 0.5 vs 2.4 +/- 0.6, P < .001) than those without lesion. Sensitivities, specificities, and accuracies for detecting LAD stenosis were 64%, 93%, and 80% for qualitative analysis of myocardial perfusion; 92%, 94%, and 93% for CFVR; 84%, 87%, and 86% for MBFR; and 80%, 97%, and 89% for beta reserve. In this selected study population, CFVR was the best index for detecting LAD stenosis (odds ratio = 1.78, 95% confidence interval = 1.28-2.47).
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Altamiro Filho Ferraz
authors.initials: AF
authors.lastname: Osório
authors.forename: Jeane Mike
authors.initials: JM
authors.lastname: Tsutsui
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kowatsch
authors.forename: Vitor Coimbra
authors.initials: VC
authors.lastname: Guerra
authors.forename: Jose Antônio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: Pedro Alves
authors.initials: PA
authors.lastname: Lemos
authors.forename: Luiz Antĉnio Machado
authors.initials: LA
authors.lastname: Cesar
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
mesh_terms: D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology