(Circulation. 1995;92:190-196.)
© 1995 American Heart Association, Inc.
Articles |
Adenosine-Induced Coronary Vasodilatation During Transesophageal Doppler Echocardiography
Rapid and Safe Measurement of Coronary Flow Reserve Ratio Can Predict Significant Left Anterior Descending Coronary Stenosis
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 1993.
From the Cardiovascular Research Institute, the Cardiology Division of the Department of Medicine, and the John Henry Mills Echocardiography Laboratory of the University of California, San Francisco.
Correspondence to Rita F. Redberg, MD, MSc, University of California, San Francisco, Moffitt Hospital, 505 Parnassus Ave, San Francisco, CA 94143-0214. E-mail redberg@cardio.ucsf.edu.
Background Less invasive methods are replacing traditional invasive means of measuring coronary flow reserve (CFR). Transesophageal echocardiography (TEE) is becoming a useful tool for evaluation of coronary artery disease and has recently been used to measure CFR. This has always been done using dipyridamole, but adenosine has a greater vasodilator potency and more favorable kinetics than dipyridamole. This study was done to evaluate the hypothesis that adenosine is safe, rapid, and accurate in measuring coronary blood flow reserve by TEE Doppler.
Methods and Results Forty-nine patients who had recently undergone angiography had a transesophageal echocardiogram with visualization of the coronary arteries and measurement of blood flow velocity in the left anterior descending coronary artery (LAD) during adenosine infusion of 0.14 mg/kg per minute. Angiograms were analyzed by quantitative coronary angiography, and significant stenosis was defined as >70% lumenal diameter narrowing. Thirty-nine of the 49 patients did not have a significant LAD stenosis (group 1); the remainder had significant disease (group 2). Good spectral Doppler recordings of blood flow velocity in the LAD were obtained in 41 of 46 patients (89%). There were no significant differences in baseline coronary blood flow velocities between the two groups. Hyperemic to baseline flow ratios were significantly higher in patients without significant LAD stenosis for peak (2.83±1.04 versus 1.78±0.36) and mean (2.68±0.96 versus 1.75±0.39) diastolic velocity. A CFR ratio >2.1 had a sensitivity of 86%, a specificity of 79%, a positive predictive value of 46%, and a negative predictive value of 96% for the absence of critical LAD stenosis. The infusion was well tolerated. It had to be prematurely terminated in only 3 patients (6.5%), and they were asymptomatic. No patient experienced chest pain, palpitations, or flushing. Intraobserver and interobserver variabilities were low, and reproducibility of data was good (<4%).
Conclusions Adenosine Doppler TEE is an effective, rapid, safe, and superior means of measuring CFR ratio. This method is convenient for serial measurements of CFR as well as in clinical settings such as evaluation of syndrome X, cardiomyopathy, and aortic regurgitation.
Key Words: echocardiography • adenosine • coronary disease
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