Key result
Transthoracic coronary Doppler echocardiography identified coronary artery disease defined by myocardial perfusion imaging with a sensitivity of 60% and a specificity of 79%.
Why the study?
Does transthoracic Doppler echocardiography of the LAD accurately detect coronary artery disease compared to myocardial perfusion imaging in patients with suspected myocardial ischemia?
Cross-Sectional (n=69)
Blinded
Does transthoracic Doppler echocardiography of the LAD accurately detect coronary artery disease compared to myocardial perfusion imaging in patients with suspected myocardial ischemia?
Effect estimate: Sensitivity 60%, Specificity 79%
p-value: p=0.043
Transthoracic Doppler echocardiography measurement of coronary flow velocity reserve in the LAD has a high negative predictive value for excluding significant coronary artery disease, though its sensitivity is limited in a heterogeneous clinical population.
BACKGROUND: Myocardial perfusion imaging (MPI), using single photon emission computed tomography (SPECT) is a validated method for detecting coronary artery disease. Transthoracic Doppler echocardiography (TTDE) of flow at rest and during adenosine provocation has previously been evaluated in selected patient groups. We therefore wanted to compare the diagnostic ability of TTDE in the left anterior descending coronary artery (LAD) to that of MPI in an unselected population of patients with chest pain referred for MPI. Our hypothesis was that TTDE with high accuracy would identify healthy individuals and exclude them from the need for further studies, enabling invasive investigations to be reserved for patients with a high probability of disease. METHODS: Sixty-nine patients, 44 men and 25 women, age 61 +/- 10 years (range 35-82), with a clinical suspicion of stress induced myocardial ischemia, were investigated. TTDE was performed at rest and during adenosine stress for myocardial scintigraphy. RESULTS: We found that coronary flow velocity reserve (CFVR) determined from diastolic measurements separated normal from abnormal MPI findings with statistical significance. TTDE identified coronary artery disease, defined from MPI, as reversible ischemia and/or permanent defect, with a sensitivity of 60% and a specificity of 79%. The positive predictive value was 43% and the negative predictive value was 88%. There was an overlap between groups which could be due to abnormal endothelial function in patients with normal myocardial perfusion having either hypertension or diabetes. CONCLUSION: TTDE is an attractive non-invasive method to evaluate chest pain without the use of isotopes, but the diagnostic power is strongly dependent on the population investigated. Even in our heterogeneous clinical cardiac population, we found that CFVR>2 in the LAD excluded significant coronary artery disease detected by MPI.
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Maret et al. (2008) conducted a cross-sectional in Suspected or known coronary artery disease (n=69). Transthoracic coronary Doppler echocardiography (TTDE) for coronary flow velocity reserve (CFVR) vs. Myocardial perfusion imaging (MPI) was evaluated on Diagnostic accuracy of CFVR for detecting coronary artery disease defined by MPI (Sensitivity 60%, Specificity 79%, p=0.043). Transthoracic coronary Doppler echocardiography identified coronary artery disease defined by myocardial perfusion imaging with a sensitivity of 60% and a specificity of 79%.
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