title: [Interest of coronary flow reserve of the LAD during dobutamine stress echocardiography].
abstract: OBJECTIVE
  To assess the value of the coronary flow reserve (CFR) in the left anterior descending artery (LAD) during dobutamine stress echocardiography in the diagnosis of significant LAD stenosis (more than 70%).
  
  
  METHODS
  Retrospective study of 81 patients with a positive stress echocardiography who underwent a coronarography.
  
  
  RESULTS
  Measurement of coronary flow reserve was able in half echocardiographic exams. Medium Pic diastolic velocity was 0.33 m/s (SD 0.20), medium maximal diastolic velocity during stress was 0.62 m/s (SD 0.20), medium CFR was 2.25 (SD 0.65). In 50 patients LAD was not seen; in five of them LAD was occluded. The predictive positive value (PPV) of a low coronary flow reserve to detect LAD stenosis is 66.7% and the negative predictive value (NPV) is 65.4%. An abnormal anterior contraction during stress echo with a low reserve has a PPV of 75% for the diagnosis of significant IVA stenosis and a normal contraction during stress with normal coronary flow reserve means a NPV of 65%. We did not show a significant correlation between low coronary flow and abnormal contraction during stress echocardiography (kappa 0.51).
  
  
  CONCLUSIONS
  Coronary flow reserve of LAD during stress echo is feasible but does not really improve exam performance to detect significant IVA stenosis. This measurement remains to be clear in coronary patients management.
authors.affiliation: Service de cardiologie, groupe hospitalier Sud-Réunion, Saint-Pierre cedex. christophe.jeannot@chr-reunion.fr
authors.forename: C
authors.initials: C
authors.lastname: Jeannot
authors.forename: E
authors.initials: E
authors.lastname: Troucelier
authors.forename: A
authors.initials: A
authors.lastname: Mercusot
authors.forename: M
authors.initials: M
authors.lastname: Riedel
authors.forename: N
authors.initials: N
authors.lastname: Dijoux
authors.forename: C
authors.initials: C
authors.lastname: Mimran
authors.forename: B
authors.initials: B
authors.lastname: Petit
authors.forename: O
authors.initials: O
authors.lastname: Geoffroy
authors.forename: G
authors.initials: G
authors.lastname: Clerici
authors.forename: M
authors.initials: M
authors.lastname: Giraud
mesh_terms: D000368:Aged; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000502:physiology*; D025401:Echocardiography, Stress; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies