title: Detection of coronary artery disease using coronary flow velocity reserve by transthoracic Doppler echocardiography versus multidetector computed tomography coronary angiography: influence of calcium score.
abstract: BACKGROUND
  There have been no clinical data specifying the degree of calcium deposition at which coronary flow velocity reserve (CFVR) measurement using transthoracic Doppler echocardiography surpasses 320-row multidetector computed tomographic coronary angiography (CTCA) in detecting obstructive coronary artery disease.
  
  
  METHODS
  One hundred seventy patients who underwent invasive coronary angiography, transthoracic Doppler echocardiography, and CTCA were prospectively enrolled. Coronary artery stenosis was defined as percentage diameter stenosis ≥ 50% on invasive coronary angiography. CFVR < 2.0 and narrowing ≥ 50% measured with CTCA were the thresholds indicating the presence of coronary artery stenosis. The degree of coronary artery calcification was also assessed using the Agatston calcium score method by computed tomography.
  
  
  RESULTS
  The majority of patients (89%) were classified as having either high or intermediate pretest probability of coronary artery disease. Significant coronary artery stenoses by invasive coronary angiography were found in 71 patients and 104 vessels. Although the overall diagnostic performance of CTCA was comparable with that of CFVR measurement for detecting coronary artery stenosis, only the diagnostic performance of CTCA was negatively affected by the extent of a patient's coronary artery calcification. Receiver operating characteristic curve analysis indicated that only CFVR measurement is diagnostically accurate when calcium scores are >319 in the patient-based assessment, 189 for the left anterior descending coronary artery, 98 for the left circumflex coronary artery and 282 for the right coronary artery.
  
  
  CONCLUSIONS
  Transthoracic Doppler echocardiography and 320-row multidetector CTCA successfully diagnosed significant coronary artery stenosis with high feasibility and accuracy. However, only the diagnostic performance of CTCA was negatively affected by the extent of a patient's coronary artery calcification, and therefore the diagnostic performance of CFVR measurement for detecting coronary artery stenosis surpassed that of CTCA when the calcium score exceeded specified cutoff values.
authors.affiliation: Department of Cardiology, Yokkaichi Social Insurance Hospital, Yokkaichi, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kakuta
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: dohik@clin.medic.mie-u.ac.jp.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.affiliation: Department of Translational Medical Science, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Yokkaichi Social Insurance Hospital, Yokkaichi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamanaka
authors.affiliation: Department of Cardiology, Yokkaichi Social Insurance Hospital, Yokkaichi, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawamura
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamori
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanigawa
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Onishi
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Mashio
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D002114:Calcinosis / Q000175:diagnosis* / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: 320-row multidetector computed tomographic coronary angiography; Calcification; Coronary artery disease; Coronary flow velocity reserve; Echocardiography