Noninvasive Evaluation of Coronary Perfusion by Transthoracic Doppler Echocardiography in Patients with Anterior Myocardial Infarction before Coronary Intervention

University Heart Journal Pub Date : 2019-05-17 DOI:10.3329/UHJ.V15I1.41442

S. Malla, Mostashirul Haque, D. Osmany, T. Parvin, Mohammad Safiuddin, S. Banerjee, S. Ahsan, C. M. Ahmed, K. M. Iqbal

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Abstract

Background: Transthoracic Doppler Echocardiography (TTDE) has made a breakthrough in noninvasive evaluation of coronary artery flow, especially in the distal left anterior descending coronary artery (LAD). The present study was intended to test the hypothesis whether TTDE can differentiate coronary perfusion with Thrombolysis in Myocardial Infarction (TIMI) grade 3 from TIMI grade ≤2 in patients with anterior myocardial infarction (AMI). Methods: A total of 30 consecutive patients suggestive of anterior MI including those who received thrombolysis with the potential need for Percutaneus Coronary Intervention (PCI) were enrolled in the study. The coronary perfusion was evaluated by antegrade flow visualization in distal LAD by Colour TTDE and antegrade flow velocity measured by pulsed TTDE followed by coronary angiogram for TIMI grade flow in culprit artery. The sensitivity, specificity and diagnostic accuracy were determined by comparing TTDE parameters with angiographic TIMI flow grade. Results: The antegrade distal LAD flow visualization by Color TTDE enabled differentiation of TIMI 3 from TIMI ≤2 with a sensitivity, specificity, PPV, NPV and diagnostic accuracy of 100%, 62.5%, 40%, 100% and 70% respectively. The Receiver Operating Characteristic (ROC) curve constructed to find the cut-off value for antegrade flow velocity in distal LAD in differentiating TIMI 3 from TIMI 0-2 was found to be 30.5 cm/ s with an area under the curve being 0.893, p =0.011. The antegrade flow velocity in distal LAD e” 30.5 cm/s by pulsed TTDE had a fair sensitivity (66.7%) , but had high specificity (100%) and overall diagnostic accuracy (86.7%). Conclusion: The study concluded that antegrade distal LAD flow visualization by Color TTDE can fairly differentiate TIMI 3 from TIMI ≤2 with high sensitivity, and moderate specificity and diagnostic accuracy. Additionally, the antegrade flow velocity in distal LAD by pulsed TTDE has a moderate sensitivity and high specificity to predict the angiographic TIMI flow grade. Thus, TTDE enables noninvasive differentiation of coronary perfusion in patients with anterior MI before coronary intervention. University Heart Journal Vol. 15, No. 1, Jan 2019; 22-27

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经胸多普勒超声心动图无创评价前路心肌梗死患者冠状动脉介入治疗前冠状动脉灌注

背景:经胸多普勒超声心动图(TTDE)在无创评估冠状动脉血流方面取得了突破，特别是在冠状动脉左前降支(LAD)远端。本研究旨在验证TTDE是否可以区分前路心肌梗死(AMI)患者冠状动脉灌注伴血栓溶解(TIMI) 3级和TIMI≤2级的假设。方法:共30例提示前路心肌梗死的连续患者，包括接受溶栓治疗并可能需要经皮冠状动脉介入治疗(PCI)的患者纳入研究。冠状动脉灌注通过彩色TTDE显示远端LAD的顺行血流，脉冲TTDE测量罪魁动脉的顺行血流速度，然后冠状动脉造影显示TIMI级血流。通过比较TTDE参数与血管造影TIMI血流分级来确定其敏感性、特异性和诊断准确性。结果:彩色TTDE顺行LAD远端血流显像可区分TIMI 3和TIMI≤2，其灵敏度、特异性、PPV、NPV和诊断准确率分别为100%、62.5%、40%、100%和70%。构建用于鉴别TIMI 3和TIMI 0-2的远端LAD顺行流速截断值的Receiver Operating Characteristic (ROC)曲线为30.5 cm/ s，曲线下面积为0.893,p =0.011。脉冲TTDE检测LAD远端顺行血流速度为30.5 cm/s，灵敏度为66.7%，特异度为100%，总体诊断准确率为86.7%。结论:彩色TTDE显示LAD远端顺行血流能较好地区分TIMI 3和TIMI≤2，灵敏度高，特异性和诊断准确性中等。此外，脉冲TTDE对远端LAD的顺行血流速度具有中等敏感性和高特异性，可预测血管造影TIMI血流等级。因此，TTDE可以在冠状动脉介入治疗前无创地鉴别前路心肌梗死患者的冠状动脉灌注。《大学心脏杂志》第15卷第1期，2019年1月;月22 - 27日

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University Heart Journal

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