Diagnostics of main coronary artery stenoses and occlusions: Multiplane transoesophageal Doppler echocardiographic assessment

Abstract

Aim and Methods: The possibility of using multiplane transoesophageal echocardiography (TEE) and quantitative coronary angiography (QCA) in the diagnostics of stenotic atherosclerosis of the main coronary arteries in a comparative aspect were studied in 94 patients with coronary artery disease (men, mean age 52 ± 7 years). Coronary arteries stenoses were calculated with Doppler echocardiography using a modified continuity equation: stenosis (%) = 100 × (1 - prestenotic VTId/stenotic VTId) where prestenotic VTId, (cm) = diastolic velocity integral in the prestenotic zone, and stenotic VTId, (cm) = in the trans-stenotic zone. Results: High sensitivity and specificity of TEE in the diagnostics of stenotic and occlusive atherosclerosis of coronary arteries were revealed. They measured 88% and 98% for the left main coronary artery (LMCA), 97% and 67% for the left descending artery (LDA), 95% and 92% for the circumflex artery (CX), 83% and 97% for the right coronary artery (RCA), respectively. A high correlation was found between the results of TEE and QCA in the diagnostics of coronary stenoses which were made for the LMCA (r=0.82 P<0.001), LDA (r=0.84, P<0.001), CX (r=0.85, P<0.001), and RCA (r=0.84, P<0.001). We developed Doppler echocardiography criteria for haemodynamically significant stenoses of coronary arteries (>50%) according to a peak diastolic velocity of the coronary blood flow, calculated as 1.4 m.s-1 for the LMCA, 0.9 m.s-1 for the LDA, and 1.1 m.s-1 for the CX. We determined Doppler echocardiography criteria of coronary arteries occlusions such as a 'break' of colour mapping, absence of Doppler spectrum and retrograde blood flow during late diastole. Conclusion: Transoesophageal Doppler evaluation of coronary blood flow with application of a modified continuity equation is an accurate, non-invasive method of coronary arteries stenoses diagnostics. © 2001 The European Society of Cardiology.