CFVR 98 % ( r = 0187,

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1 Chin J Cardiol February 2003 Vol1 31 No12 91 Thomas Bartel Holger Eggebrecht Loredana Latina Raimund Erbel (LAD) (CFVR) 46 LAD CFVR CFVR 98 % 60 % CFVR ( r = 0187 P < 01001) CFVR ; New noninvasive method for the evaluation of coronary flow velocity reserve : contrast2enhanced transthoracic Doppler echocardiography with second harmonic technique YANG Ya 3 Thomas Bartel Holger Eggebrecht et al1 3 Institute of Cardiovascular Disease Tongji Medical College Huazhong University of Technology and Science Wuhan China Abstract Objective To evaluate the feasibility safety and accuracy of detecting coronary flow velocity reserve ( CFVR) by contrast2enhanced transthoracic Doppler echocardiography ( TTDE) with second harmonic technique1 Methods Doppler flow signal in the distal left anterior descending coronary artery (LAD) was assessed by contrast2ehanced TTDE with second harmonic technique in 46 patients1 The following grade was used for color Doppler and pulsed2wave ( PW) Doppler signal quality : Grade I: flow mapping not obtainable or of very poor quality; Grade II: not well defined PW Doppler tracings incomplete ; Grade III: optimal recording well delineated with complete biphasic PW Doppler tracings of systolic and diastolic flow1 CFVR was calculated as the ratio of hyperemic average peak velocity(apvh) to baseline average peak velocity(apvb) 1 Results The Doppler signal quality was significantly improved by use of the echocardiographic contrast agent(levovist) 1 The color and PW Doppler flow was not visible only in 1(2 %) patients1 In 45 (98 %) of 46 patients CFVR was successfully determined with intravenous Levovist infusion1 Heart rate increased blood pressure decreased significantly after adenosine infusion 60 % patients experienced mild side effects1 APVb [ ( ) cmπs] APVh [ ( ) cmπs ] and CFVR ( ) determined from TTDE were closely correlated with those from intracoronary Doppler measurements [ (APVb : ( ) cmπs APVh : ( ) cmπs CFVR : ]1 Conclusion TTDE is a feasible safe method and provides reliable data on CFVR which can be used for the assessment of coronary stenosis coronary microcirculation and for follow2up after coronary intervention1 Key words Echocardiography Doppler ; Flow reserve coronary [1 2 (transthoracic Doppler CFR) ] TTDE echocardiography TTDE) ( 2 ) TTDE ( (LAD) ) ( coronary flow reserve (coronary flow velocity reserve CFVR) : ( ) ; ( Thomas Bartel Holger Eggebrecht Loredana Latina Raimund Erbel) CFRCFVR [3 ] TTDE LAD

2 Chin J Cardiol February 2003 Vol1 31 No12 (intracoronary Doppler ICD) CFVR 46 ( ) [ ( PTCA) 19 PTCA 4 ] (58 10) [ > 200mm Hg (1 mm Hg = 01133kPa) > 110mm Hg] ( < 90mm Hg) TTDE ICD 48h Sequoia C256 3V2c 015 TTDE APV 2 CFVR (Average peak velocity LAD during hyperamia APVh) LAD (Average peak velocity at baseline APVb) CFVR 12 1 LAD (1) 5min ICD 200mgΠml 8F LAD mlΠmin 15MHz LAD [4 ] : ; 18g : APVb APVh CFVR APV ; : CFVR ( gx s) LAD LAD t TTDE ICD LAD 30 P < 0105 LAD 50g kg - 1 min - 1 1min 1min (2) 46 75g kg - 1 min g kg - 1 min g kg - 1 min g kg - 1 min LAD A B C LAD D LAD IVS LV RV ECG 13 ( 28 %) 23 ( 50 %) 10 (20 %) ; 16 (35 %) 5minTTDE ICD 24 (52 %) 6 (13 %) ; ( Average peak velocity APV ) 1 (2 %) 4 (9 %) 41

3 Chin J Cardiol February 2003 Vol1 31 No12 93 (89 %) ; 1 (2 %) 6 (13 %) 39 (85 %) ;1 LAD TTDE LAD 98 % 2 A B 100g kg - 1 min % 8m 50g kg - 1 min - 1 2m LAD Bartel [2 ] 20 LAD 140g kg - 1 min - 1 (1) 65 % % TTDE LAD ( 56 %) CFVR TTDE (20 %) ( 16 %) 46 LAD (13 %) (13 %) 12min 20 % 13 % TTDE APVb APVh CFVR ICD (2) LAD [6 CFVR ] TTDE 11 TTDE LAD : ( ) LAD Hozumi [1 ] 23 LAD CFVR 78 % 89 % 85 % ( P < 01001) 1 ( CFR ) TTDE LAD 98 % [3 5 ] CFR Caiati [7 ] [3 ICD ] LAD 100 %Caiati 16 % 1 ( gx s n = 45) 50 g kg - 1 min g kg - 1 min g kg - 1 min g kg - 1 min : 3 P < 0. 05

4 Chin J Cardiol February 2003 Vol1 31 No12 2 TTDE ICD ( gx s) TTDE ICD r P APVb(cmΠs) y = 0. 58x < APVh(cmΠs) y = 0. 40x < CFVR y = 0. 77x < % TTDE ICD CFVR TTDE PTCA CFVR ICD TTDE 12min (3) CFVR : 21TTDE CFVR : TTDE LAD CFVR [11 12 CFVR ICD ICD ] CFVR CFVR 12mg QT (36h) 41 : TTDE CFVR 140g kg - 1 min - 1 (1) [5 8 ] TTDE CFVR LAD CFVR LAD LAD LAD APVb APVh TTDE CFVR CFVR ICD TTDE ( TEE) CFVR CFVR 31 : CFVR PTCA LAD [13 (1) : ] TTDE CFVR CFVR ( < 40 %) (40 %75 %) (2) TTDE CFVR CFVR ( P < 0105) CFVR 210 LAD ( > LAD CFVR > 3 CFVR(2) :PTCA ICD CFVR 215 CFVR CFVR TTDE CFR DEBATE CFVR (3) CFVR LAD [9 PTCA ] LAD PTCA CFVR [10 ] CFVR TEE LAD Caiati [7 ] 77 LAD CFVR Erbel [10 ] 44 ICD 75 %) 91 % 76 %TTDE 16 (36 %) CFVR

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