title: Angiographically borderline left main coronary artery lesions: correlation of transthoracic doppler echocardiography and intravascular ultrasound: a pilot study.
abstract: BACKGROUND
  the clinical decision making could be difficult in patients with borderline lesions (visually assessed stenosis severity of 30 to 50%) of the left main coronary artery (LM). The aim of the study was to evaluate the relationship between transthoracic Doppler (TTDE) peak diastolic flow velocity (PDV) and intravascular ultrasound (IVUS) measurements in the assessment of angiographically borderline LM lesions.
  
  
  METHODS
  27 patients (mean age 64 ± 8 years, 21 males) with borderline LM stenosis referred for IVUS examination were included in the study. We performed standard IVUS with minimal lumen area (MLA) and plaque burden (PB) measurement and routine quantitative coronary angiography (QCA) with diameter stenosis (%DS) and area stenosis (%AS) assessment in all. During TTDE, resting PDV was measured in the LM.
  
  
  RESULTS
  interpretable Doppler signal could be obtained in 24 patients (88% feasibility); therefore these patients entered the final analysis. MLA was 7.1 ± 2.7 mm2. TTDE measured PDV correlated significantly with IVUS-derived MLA (r = -0.46, p < 0.05) and plaque burden (r = 0.51, p < 0.05). Using a velocity cut-off of 112 cm/sec TTDE showed a 92% sensitivity and 62% specificity to identify IVUS-significant (MLA < 6 mm2) LM stenosis.
  
  
  CONCLUSIONS
  In angiographically borderline LM disease, resting PDV from transthoracic echocardiography is increased in presence of increased plaque burden by IVUS. TTDE evaluation might be a useful adjunct to other invasive and non-invasive methods in the assessment of borderline LM lesions. Further, large scale studies are needed to establish the exact cut-off value of PDV for routine clinical application.
authors.affiliation: Department of Medicine and Cardiology Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, H-6724, Szeged, Pécsi str, 4, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Ruzsa
authors.forename: Attila
authors.initials: A
authors.lastname: Pálinkás
authors.forename: Tamás
authors.initials: T
authors.lastname: Forster
authors.forename: Imre
authors.initials: I
authors.lastname: Ungi
authors.forename: Albert
authors.initials: A
authors.lastname: Varga
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003326:Coronary Circulation / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional / Q000379:methods*