Key result
Quantitative evaluation of coronary flow velocities using transthoracic echocardiography demonstrated 80% sensitivity and 98% specificity for detecting >50% stenosis in the left main and left anterior descending coronary arteries.
Why the study?
Does non-contrast transthoracic echocardiography accurately detect >50% stenosis in the left main coronary artery and left anterior descending artery compared to quantitative coronary angiography in patients with chest pain?
Cross-Sectional (n=173)
No
Does non-contrast transthoracic echocardiography accurately detect >50% stenosis in the left main coronary artery and left anterior descending artery compared to quantitative coronary angiography in patients with chest pain?
Effect estimate: Sensitivity 80%, Specificity 98%, Accuracy 95%
p-value: p=<0.001
Quantitative transthoracic echocardiography using the flow continuity equation or stenotic-to-prestenotic velocity ratio provides high diagnostic accuracy for detecting >50% stenosis in the left main and left anterior descending coronary arteries.
Does not support replacing angiography; leaves open validation in larger prospective studies.
Purpose. To detect the potential of different qualitative, semi-quantitative and quantitative transthoracic Doppler signs for successful evaluation of stenotic left main coronary artery (LMCA) and left anterior descending artery (LAD). Materials and methods. 173 patients (52±10 years; 149 men) with chest pain, sinus rhythm and scheduled quantitative coronary angiography (CAG) were evaluated at rest by non-contrast transthoracic echocardiography (TT E). LMCA and proximal (p), mid (m) and distal (d) parts of the LAD were examined. The Doppler signs of coronary stenosis >50 % were determined as follows: 1 – local Doppler aliasing with the Nyquist limit set at 60 cm/s; 2 – maximal peak diastolic velocity (Vpd) >60 cm/s; 3 – ratio of stenotic/prestenotic Vpd >2.0; 4 – stenosis >50 % according to flow continuous equation: stenosis, % = 100 × (1 – prestenotic VTId / stenotic VTId), where VTId – diastolic time velocity integral. CAG was performed within 1 week after TT E. Stenosis >50 % of diameter reduction was considered as significant. Results. Sensitivity (Sens), specificity (Sp) and diagnostic accuracy (Ac) of different Doppler stenotic signs for stenotic LMCA and LAD are presented in Table 1. Thus, TT E is a method for correct evaluation of stenotic LMCA and LAD. Quantitative ratio of stenotic to prestenotic coronary flow velocities is a more sensitive sign for detecting stenosis >50 %, than qualitative and semi-quantitative evaluation of maximal coronary flow velocity only.
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Boshchenko et al. (2016) conducted a cross-sectional in Suspected coronary artery disease (n=173). Transthoracic echocardiography (TTE) vs. Quantitative coronary angiography (CAG) was evaluated on Diagnostic accuracy (sensitivity and specificity) for detecting >50% stenosis in LMCA and LAD using the flow continuity equation (Sensitivity 80%, Specificity 98%, Accuracy 95%, p=<0.001). Quantitative evaluation of coronary flow velocities using transthoracic echocardiography demonstrated 80% sensitivity and 98% specificity for detecting >50% stenosis in the left main and left anterior descending coronary arteries.
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