title: Transthoracic Doppler for detection of stenoses in the three main coronary arteries by use of stenotic to prestenotic velocity ratio and aliased coronary flow.
abstract: OBJECTIVE
  Our aim was to determine the feasibility and accuracy of diagnosing significant coronary artery stenoses using peak stenotic to prestenotic velocity ratio (pSPVR) measurements when compared with results from quantitative coronary angiography and coronary flow velocity reserve (CFVR) assessed by transthoracic echocardiography (TTE).
  
  
  RESULTS
  One hundred and eight patients scheduled for coronary angiography were studied using transthoracic Doppler echocardiography. Stenoses were identified by local colour aliasing by colour flow Doppler, and further evaluated by pSPVR, using a pSPVR of ≥2.0 as a cut-off for significant stenosis. When pSPVR could not be measured, local mosaic coronary flow pattern at Nyquist limit ≥0.48 m/s was used. Sixty-five lesions suggestive of stenosis were found by TTE. Combining findings of pSPVR ≥2.0 and local mosaic flow at Nyquist limit ≥0.48 m/s, the sensitivity and specificity of demonstrating significant stenoses (diameter stenosis, 50-99%) in the left main coronary artery (LM), left anterior descending coronary (LAD), left circumflex coronary (Cx), and right coronary artery (RCA) were 75 and 98%, 74 and 95%, 40 and 87%, and 34 and 98%, respectively. The pSPVR did not differ significantly between arteries with reduced and normal CFVR, with a cut-off of CFVR <2.0.
  
  
  CONCLUSIONS
  Findings of pSPVR ≥2.0 or localized colour flow aliasing are useful in the non-invasive diagnosis of significant coronary disease in the three main coronary arteries, with high specificity for detecting significant stenoses. These findings showed high sensitivity for identifying significant stenoses in the LM and LAD, but showed lower ability to detect those lesions in the Cx and RCA.
authors.affiliation: Department of Internal Medicine, Ålesund Hospital, Ålesund, Norway Department of Cardiology, Trondheim University Hospital, 7006 Trondheim, Norway espen.holte@stolav.no es-holte@online.no.
authors.forename: Espen
authors.initials: E
authors.lastname: Holte
authors.affiliation: Department of Internal Medicine, Ålesund Hospital, Ålesund, Norway.
authors.forename: Johnny
authors.initials: J
authors.lastname: Vegsundvåg
authors.affiliation: Department of Cardiology, Trondheim University Hospital, 7006 Trondheim, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Hegbom
authors.affiliation: Department of Internal Medicine, Ålesund Hospital, Ålesund, Norway Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Torstein
authors.initials: T
authors.lastname: Hole
authors.affiliation: Department of Cardiology, Trondheim University Hospital, 7006 Trondheim, Norway Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Rune
authors.initials: R
authors.lastname: Wiseth
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology*; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Coronary colour; Coronary stenosis; Doppler flow aliasing; Nyquist limit; Stenotic to prestenotic velocity ratio; Transthoracic echocardiography