Key result
A resting coronary flow velocity of ≥70 cm/s in the left main or proximal LAD identified angiographically silent but significant lesions by IVUS or FFR in 94% of patients.
Why the study?
Coronary artery stenosis can be underestimated by coronary angiography, and it was hypothesized that high Doppler velocity in the left main or proximal LAD could identify angiographically silent narrowing.
Does a local high velocity (≥70 cm/s) measured by Doppler echocardiography indicate angiographically silent significant narrowing of the left main/proximal LAD in patients with positive stress echo and mild angiographic stenoses?
Cohort (n=18)
No
Does a local high velocity (≥70 cm/s) measured by Doppler echocardiography indicate angiographically silent significant narrowing of the left main/proximal LAD in patients with positive stress echo and mild angiographic stenoses?
A resting coronary flow velocity ≥70 cm/s by transthoracic Doppler echocardiography strongly predicts significant left main or proximal LAD stenosis by IVUS/FFR, even when coronary angiography shows non-significant (0-40%) narrowing.
Background: Knowing that stenosis of coronary arteries can be underestimated by coronary angiography.Purpose: We hypothesized that a local high velocity -≥70 cm/s as measured by Doppler echocardiography -in left main and/or in the proximal portion of left anterior descending (LAD) in patients who had ischemic stress echo test and no/mild stenoses of these arteries by angiography could indicate angiographically silent significant narrowing of the arteries.Methods: Among a cohort of 1001 patients referred for stress echocardiography, we selected as our group persons who had coronary flow velocities at rest ≥70 cm/s in left main/proximal LAD, positive stress echocardiography test with wall abnormalities in LAD territories, and stenoses 0-40% in the corresponding portions of left main/ proximal LAD by coronary angiography.The group underwent intravascular ultrasound (IVUS) or fractional flow reserve (FFR) for assessment of the interrogated segment of the coronary artery. Results:We identified 18 patients (15 men, 59±12 years old) who met the inclusion criteria.Eleven patients underwent IVUS, while seven were assigned for FFR.Lesions of left main/proximal LAD segments proved significant in 17 patients (94%, 95% CI 79-99%). Conclusion:A flow velocity in left main/proximal LAD of more than 70 cm/s could be an indication for performing IVUS/FFR in patients with discrepancies between coronary angiography and stress tests.
No takes yet. Share an insight, caveat, or question.
Zagatina et al. (2021) conducted a cohort in Coronary artery disease with angiographically silent lesions (n=18). Coronary flow velocity ≥70 cm/s by Doppler echocardiography was evaluated on Significant lesion of left main/proximal LAD segments confirmed by IVUS or FFR (95% CI 79-99). A resting coronary flow velocity of ≥70 cm/s in the left main or proximal LAD identified angiographically silent but significant lesions by IVUS or FFR in 94% of patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: