Author + information
- Received August 29, 1994
- Revision received November 29, 1994
- Accepted December 8, 1994
- Published online April 1, 1995.
- Manfred Zehetgruber, MD*,
- Gerald Mundigler, MD,
- Günter Christ, MD,
- Deddo Mörtl, CM,
- Peter Probst, MD, FACC,
- Helmut Baumgartner, MD,
- Gerald Maurer, MD, FACC and
- Peter Siostrzonek, MD
- ↵*Address for correspondence: Dr. Manfred Zehetgruber, Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, Vienna, A-1090, Austria.
Objectives. This study sought to determine the feasibility of coronary sinus flow velocity analysis by transesophageal Doppler echocardiography for estimation of coronary flow reserve in patients with syndrome X and patients with coronary artery disease.
Background. Coronary flow reserve provides useful information in patients with coronary artery disease and patients with syndrome X. Current methods of measuring coronary flow reserve are invasive or require extensive laboratory equipment, or both. Transesophageal Doppler recordings of coronary sinus flow velocity before and after vasodilator application may allow noninvasive determination of coronary flow reserve.
Methods. We obtained coronary sinus flow velocity recordings before and after dipyridamole administration (0.6 mg/kg body weight per 5 min) in 9 patients with syndrome X, 14 with significant left coronary artery disease and 22 age-matched control patients. We used the formula anterograde minus retrograde flow velocity time integral times heart rate as an index of coronary sinus flow. Coronary flow reserve was calculated by dividing coronary sinus flow variables after dipyridamole administration by the respective baseline values.
Results. Technically adequate recordings were obtained in 44 (98%) of 45 patients. Compared with that in the control group (2.78 ± 0.95 [mean ±SD]), coronary flow reserve was significantly lower in patients with syndrome X (1.21 ± 0.23, p ≤ 0.001) as well as in those with coronary artery disease (1.47 ± 0.7, p ≤ 0.001). Using a cutoff coronary flow reserve value of 1.8, sensitivity, specificity and overall predictive value of coronary flow reserve determinations were, respectively, 100%, 91% and 94% for syndrome X and 86%, 91% and 89% for coronary artery disease.
Conclusions. Coronary flow reserve calculation by transesophageal coronary sinus flow velocity recordings is feasible in a large proportion of patients and might be useful for the noninvasive evaluation of patients with syndrome X and patients with severe left coronary artery disease.
This work was presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Georgia, November 1993.
- Received August 29, 1994.
- Revision received November 29, 1994.
- Accepted December 8, 1994.
- North American Society of Pacing and Electrophysiology; American College of Cardiology; American Heart Association, Inc.; and European Society of Cardiology.