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Transthoracic echocardiography for imaging of the different coronary artery segments: a feasibility study.

Vegsundvåg J, Holte E, Wiseth R, Hegbom K, Hole T - Cardiovasc Ultrasound (2009)

Bottom Line: If any part of the individual segment of a coronary artery with antegrade blood flow was not visualised, the segment was labeled as not satisfactorily seen.With antegrade directed coronary artery flow, the proximal, middle and distal segments of LAD were completely seen in 96%, 95% and 91% of patients, respectively.With antegrade directed coronary artery flow, the proximal, middle and distal segments of Cx were completely seen in 88%, 61% and 3% and in RCA in 40%, 28% and 54% of patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Alesund Hospital, Alesund, Norway. johnnyvegsundvag@adsl.no

ABSTRACT

Background: Transthoracic echocardiography (TTE) may be used for direct inspection of various parts of the main coronary arteries for detection of coronary stenoses and occlusions. We aimed to assess the feasibility of TTE to visualise the complete segments of the left main (LM), left descending (LAD), circumflex (Cx) and right (RCA) coronary arteries.

Methods: One hundred and eleven patients scheduled for diagnostic coronary angiography because of chest pain or acute coronary syndrome had a TTE study to map the passage of the main coronary arteries. LAD, Cx and RCA were each divided into proximal, middle and distal segments. If any part of the individual segment of a coronary artery with antegrade blood flow was not visualised, the segment was labeled as not satisfactorily seen.

Results: Complete imaging of the LM was achieved in 98% of the patients. With antegrade directed coronary artery flow, the proximal, middle and distal segments of LAD were completely seen in 96%, 95% and 91% of patients, respectively. Adding the completely seen segments with antegrade coronary flow and segments with retrograde coronary flow, the proximal, middle and distal segments of LAD were adequately visualised in 96%, 96% and 93% of patients, respectively. With antegrade directed coronary artery flow, the proximal, middle and distal segments of Cx were completely seen in 88%, 61% and 3% and in RCA in 40%, 28% and 54% of patients. Retrograde coronary artery flow was correctly identified as verified by coronary angiography in seven coronary segments, mainly in the posterior descending artery (labeled as the distal segment of RCA) and distal LAD.

Conclusions: TTE is a feasible method for complete demonstration of coronary flow in the LM, the proximal Cx and the different segments of LAD, but less suitable for the RCA and mid and distal segments of the Cx. (ClinicalTrials.gov number NTC00281346.).

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Examples of antegrade and retrograde flow in the middle segment of LAD. The middle segment of the left anterior descending coronary artery (mLAD) imaged by colour Doppler mapping and matching spectral Doppler tracings of blood flow, imaged from modified parasternal short-axis view focusing on the anterior interventricular sulcus: (A) The mLAD is seen with antegrade flow. (B) The mLAD is seen with retrograde flow. D = spectral Doppler tracings of diastolic coronary blood flow; IVS = interventricular septum; LV = left ventricle; RV = right ventricle; S = spectral Doppler tracings of systolic coronary blood flow.
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Figure 6: Examples of antegrade and retrograde flow in the middle segment of LAD. The middle segment of the left anterior descending coronary artery (mLAD) imaged by colour Doppler mapping and matching spectral Doppler tracings of blood flow, imaged from modified parasternal short-axis view focusing on the anterior interventricular sulcus: (A) The mLAD is seen with antegrade flow. (B) The mLAD is seen with retrograde flow. D = spectral Doppler tracings of diastolic coronary blood flow; IVS = interventricular septum; LV = left ventricle; RV = right ventricle; S = spectral Doppler tracings of systolic coronary blood flow.

Mentions: The coronary artery flow velocity waveform appears as a complex of a small wave in systole and a large trapezoid wave in diastole (Figure 6A). The coronary artery antegrade flow velocities could be low, normal or elevated, and was not always measured. The colour Doppler flow could either be laminar or turbulent. When colour flow Doppler recordings indicated reversed coronary artery flow (the functional diagnosis of coronary obstruction more proximal in the coronary artery), we distinguished the retrograde coronary artery flow from coronary venous flow by finding inverted coronary flow velocity waveform (Figure 6B). In contrast, the coronary venous flow appears as a prominent systolic flow wave.


Transthoracic echocardiography for imaging of the different coronary artery segments: a feasibility study.

Vegsundvåg J, Holte E, Wiseth R, Hegbom K, Hole T - Cardiovasc Ultrasound (2009)

Examples of antegrade and retrograde flow in the middle segment of LAD. The middle segment of the left anterior descending coronary artery (mLAD) imaged by colour Doppler mapping and matching spectral Doppler tracings of blood flow, imaged from modified parasternal short-axis view focusing on the anterior interventricular sulcus: (A) The mLAD is seen with antegrade flow. (B) The mLAD is seen with retrograde flow. D = spectral Doppler tracings of diastolic coronary blood flow; IVS = interventricular septum; LV = left ventricle; RV = right ventricle; S = spectral Doppler tracings of systolic coronary blood flow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2806270&req=5

Figure 6: Examples of antegrade and retrograde flow in the middle segment of LAD. The middle segment of the left anterior descending coronary artery (mLAD) imaged by colour Doppler mapping and matching spectral Doppler tracings of blood flow, imaged from modified parasternal short-axis view focusing on the anterior interventricular sulcus: (A) The mLAD is seen with antegrade flow. (B) The mLAD is seen with retrograde flow. D = spectral Doppler tracings of diastolic coronary blood flow; IVS = interventricular septum; LV = left ventricle; RV = right ventricle; S = spectral Doppler tracings of systolic coronary blood flow.
Mentions: The coronary artery flow velocity waveform appears as a complex of a small wave in systole and a large trapezoid wave in diastole (Figure 6A). The coronary artery antegrade flow velocities could be low, normal or elevated, and was not always measured. The colour Doppler flow could either be laminar or turbulent. When colour flow Doppler recordings indicated reversed coronary artery flow (the functional diagnosis of coronary obstruction more proximal in the coronary artery), we distinguished the retrograde coronary artery flow from coronary venous flow by finding inverted coronary flow velocity waveform (Figure 6B). In contrast, the coronary venous flow appears as a prominent systolic flow wave.

Bottom Line: If any part of the individual segment of a coronary artery with antegrade blood flow was not visualised, the segment was labeled as not satisfactorily seen.With antegrade directed coronary artery flow, the proximal, middle and distal segments of LAD were completely seen in 96%, 95% and 91% of patients, respectively.With antegrade directed coronary artery flow, the proximal, middle and distal segments of Cx were completely seen in 88%, 61% and 3% and in RCA in 40%, 28% and 54% of patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Alesund Hospital, Alesund, Norway. johnnyvegsundvag@adsl.no

ABSTRACT

Background: Transthoracic echocardiography (TTE) may be used for direct inspection of various parts of the main coronary arteries for detection of coronary stenoses and occlusions. We aimed to assess the feasibility of TTE to visualise the complete segments of the left main (LM), left descending (LAD), circumflex (Cx) and right (RCA) coronary arteries.

Methods: One hundred and eleven patients scheduled for diagnostic coronary angiography because of chest pain or acute coronary syndrome had a TTE study to map the passage of the main coronary arteries. LAD, Cx and RCA were each divided into proximal, middle and distal segments. If any part of the individual segment of a coronary artery with antegrade blood flow was not visualised, the segment was labeled as not satisfactorily seen.

Results: Complete imaging of the LM was achieved in 98% of the patients. With antegrade directed coronary artery flow, the proximal, middle and distal segments of LAD were completely seen in 96%, 95% and 91% of patients, respectively. Adding the completely seen segments with antegrade coronary flow and segments with retrograde coronary flow, the proximal, middle and distal segments of LAD were adequately visualised in 96%, 96% and 93% of patients, respectively. With antegrade directed coronary artery flow, the proximal, middle and distal segments of Cx were completely seen in 88%, 61% and 3% and in RCA in 40%, 28% and 54% of patients. Retrograde coronary artery flow was correctly identified as verified by coronary angiography in seven coronary segments, mainly in the posterior descending artery (labeled as the distal segment of RCA) and distal LAD.

Conclusions: TTE is a feasible method for complete demonstration of coronary flow in the LM, the proximal Cx and the different segments of LAD, but less suitable for the RCA and mid and distal segments of the Cx. (ClinicalTrials.gov number NTC00281346.).

Show MeSH
Related in: MedlinePlus