Prediction of left anterior descending coronary artery disease by esophageal echocardiography.

In order to evaluate left anterior descending coronary artery (LAD) lesions proximal or distal to the first septal branch and to detect geomerical change of the left ventricular (LV) chamber, esophageal and conventional echocardiographies were performed on 18 patients who had more than 75% narrowing of the LAD and on 21 normal control subjects. In the 17 LAD disease patients with adequate echocardiograms, the interventricular septum (IVS) and left ventricular anterior wall (LVAW) excursions were evaluated and used to predict the site of the angiographically determined LAD lesions. The 5 patients with distal LAD lesions had normal septal excursions. However, 4 of them (80%) had diminished or absent LVAW excursions. On the other hand, the 12 patients with proximal LAD lesions had diminished LVAW excursions and 9 of them (75%) had diminished or absent septal excursions. In the presence of coronary artery disease, reduced or absent IVS and LVAW excursion on echocardiograms strongly suggests LAD lesions proximal to the first septal brach. On the other hand, normal IVS and abnormal LVAW excursion suggests the presence of distal LAD lesions.In normal subjects, there was good agreement between the dimension of the LV chamber from the LVAW to the left ventricular posterior wall (LVPW) measured by esophageal echocardiography and the dimension of the LV chamber from the IVS to the LVPW measured by conventional echocardiography. However, in most patients with LAD lesions, the esophageal echocardiographic dimension was larger than the conventional echocardiographic dimension, especially when asynergy was severe. The geometrical change probably explains this disparity.Echocardiography, especially esophageal echocardiography, may be a useful noninvasive method in predicting the location of the LAD lesions and in detecting left ventricular geometrical change of patients with coronary artery disease.