title: Coronary artery occlusions diagnosed by transthoracic Doppler.
abstract: BACKGROUND
  Our aim was to assess whether anterograde flow velocities in septal perforating branches could identify an occluded contralateral coronary artery, and to assess the feasibility and accuracy of diagnosing occlusions in the three main coronary arteries by the combined use of several noninvasive parameters indicating collateral flow.
  
  
  METHODS
  A total of 108 patients scheduled for coronary angiography because of chest pain or acute coronary syndromes were studied using transthoracic Doppler echocardiography.
  
  
  RESULTS
  Anterograde peak diastolic flow velocities (pDV) in septal perforating branches were higher in patients with angiographic occluded contralateral artery compared with corresponding velocities in patients without significant disease in the contralateral artery (0.80 ± 0.31 m/sec versus 0.37 ± 0.13 m/sec, p < 0.001). Receiver operating characteristic curve showed pDV ≥ 0.57 m/sec to be the optimal cutoff value to identify occluded contralateral artery, with a sensitivity of 79% and a specificity of 69%. Demonstration of at least one positive parameter (retrograde flow in main coronary arteries, reversed flow in septal perforating and left circumflex marginal branches, pDV ≥ 0.57 m/sec, or demonstration of other epicardial or intramyocardial collaterals) indicating collateral flow to an occluded main coronary artery had sensitivity, specificity, positive and negative predictive value of 89%, 94%, 63%, and 99%, respectively, for detection of a coronary occlusion. With this combined use of several parameters, 25 of 28 coronary occlusions were identified.
  
  
  CONCLUSIONS
  By investigating several parameters indicating collateral flow, we were able to identify most of the main coronary occlusions in the patient cohort. Furthermore, our study demonstrated that coronary artery occlusions may result in complex and diverging coronary pathophysiology depending on which coronary artery segment is occluded and the extent of accompanying coronary artery disease.
  
  
  BACKGROUND
  ClinicalTrials.gov number NTC00281346.
authors.affiliation: Department of Internal Medicine, Ålesund Hospital, Ålesund, Norway. johnnyvegsundvag@mimer.no.
authors.forename: Johnny
authors.initials: J
authors.lastname: Vegsundvåg
authors.forename: Espen
authors.initials: E
authors.lastname: Holte
authors.forename: Rune
authors.initials: R
authors.lastname: Wiseth
authors.forename: Knut
authors.initials: K
authors.lastname: Hegbom
authors.forename: Torstein
authors.initials: T
authors.lastname: Hole
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D001783:Blood Flow Velocity; D002637:Chest Pain / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results