Transthoracic echocardiographic imaging of coronary arteries: tips, traps, and pitfalls

The aim of this paper is to highlight coronary investigation by transthoracic Doppler evaluation. This application has recently been introduced into clinical practice and has received enthusiastic feedback in terms of coronary flow reserve evaluation on left anterior coronary artery disease diagnosis. Such diagnosis represents the most important clinical application but has in itself some limitations regarding anatomical and technological knowledge. The purpose of this paper is to offer a didactic approach on how to investigate the different segments of left anterior and posterior descending coronary arteries by transthoracic ultrasound using different anatomical key structures .as marker

Live 3-D stress echo: is beauty also a sign of intelligence?

Background: Last generation 3-D live stress echo has potential for adding "beauty" (seductive display) and also "intelligence" (unique quantitative information) to the robust, albeit qualitative, classic 2-D stress echo based on wall motion analysis. Aim: to assess feasibility of 3-D stress echo. Materials and methods: From May 2005, we enrolled 214 consecutive patients (age=64?11 years; 88 females) routinely screened for suspect coronary artery disease with dipyridamole (0.84 mg/kg in 6\u27) stress echo. Transthoracic echocardiography (2D, 3D and coronary flow reserve, CFR, by pulsed Doppler) was performed with commercially available systems (iE33) using phase array probes (1-5 and 3-8 MHz, S5-S8) and a matrix 3D probe for 3D-Live application. Each data set was analyzed with a dedicated software (3DQ, QLab - Advanced Ultrasound Quantification Software - vs. 4.1 and 4.2, Philips Electronics), including 3D volumes and dissynchrony index (DI), considered as the mean value of standard deviation of maximum time to systolic volume variation. Results: Interpretable 2D data were obtained in all pts (100 % feasibility), CFR data on left anterior descending artery in 185 pts (88 %) and 3D data in 151 pts (70 %). In the 48 pts with negative stress echo (for wall motion criteria) by 2D and 3D, 3D-DI decreased (rest=1.3?.8 vs. stress=.99?.54, p<.001): see figure. In patients with normal resting echo and positive stress echo, 3D-DI increased (rest= 4.5?1.9 vs. stress= 8.3?3.2, p<0.01). Last generation live 3D dipyridamole stress echo still suffers a feasibility gap vs. 2D and Doppler-CFR stress echo, but shows potential for adding substantial "beauty" (convincing display) and perhaps some extra-"intelligence" (quantitative support) to classic stress echo

Transthoracic echocardiographic imaging of coronary arteries: tips, traps, and pitfalls

Abstract The aim of this paper is to highlight coronary investigation by transthoracic Doppler evaluation. This application has recently been introduced into clinical practice and has received enthusiastic feedback in terms of coronary flow reserve evaluation on left anterior coronary artery disease diagnosis. Such diagnosis represents the most important clinical application but has in itself some limitations regarding anatomical and technological knowledge. The purpose of this paper is to offer a didactic approach on how to investigate the different segments of left anterior and posterior descending coronary arteries by transthoracic ultrasound using different anatomical key structures .as markers We will conclude by underlining that, nowadays, innovative technology allows complete evaluation of both major coronary arteries in many patients in a resting condition as well as during pharmacology stress-tests, but we often do not know it.</p

The prognostic value of Doppler echocardiographic derived coronary flow reserve is not affected by concomitant anti-ischemic therapy at the time of testing

Background: When wall motion abnormality is the diagnostic end-point, concomitant anti-ischemic therapy heavily modulates the prognostic value of dipyridamole echo test (DET). Coronary flow reserve (CFR) was added to wall motion in dual imaging DET. Aim: to determine whether antianginal medications affect the prognostic value of Doppler echocardiographic derived CFR in patients with known or suspected coronary artery disease undergoing DET. Methods: We evaluated 1506 patients (911 males; 64?11 years) who underwent high dose dipyridamole (0.84 mg/kg over 6&#039;) stress echo with CFR evaluation of LAD by Doppler. Six-hundred fifty eight (44%) patients were on antiischemic therapy at time of testing. Results: Mean CFR was 2.3.?0.6. During a median follow-up of 42 months, 74 events occurred: 24 deaths and 50 nonfatal myocardial infarctions. Survival was highest in 955 patients with normal (>2.0) CFR and lowest in 951 patients with abnormal CFR (93% vs 63%, p= 0.0001). Concomitant therapy did not affect prognostic value of CFR (figure). At multivariable analysis, angina during DET (hazard ratio [HR] 2.6, 95% CI 1.6 - 4.4, P= .000), WMSI at peak stress (hazard ratio [HR] 2.2, 95% CI 1.2 - 3.9, P= .007), DET positivity for regional wall motion abnormalities (hazard ratio [HR] 6.4, 95% CI 3.5 - 11.7, P= .000), a CFR of LAD <2 (hazard ratio [HR] 2.4, 95% CI 1.4-4.1, P =.001), were independent prognostic predictors of hard cardiac events. Conclusion: Ongoing antiischemic therapy at the time of testing does not modulate the prognostic value of CFR