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Published in: Journal of Echocardiography 2/2017

01-06-2017 | Review Article

Noninvasive assessment of coronary blood flow by transthoracic Doppler echocardiography: basic to practical use in the emergency room

Author: Nozomi Watanabe

Published in: Journal of Echocardiography | Issue 2/2017

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Abstract

Echo Doppler is widely available in the clinical setting, and the feasibility of coronary flow detection in the left anterior descending coronary artery has been reported as >90% with the use of a high-frequency transducer. Coronary flow detection takes only a few minutes by skilled echocardiologists, and this noninvasive technique can provide useful physiological information in patients with various types of coronary artery disease. Coronary flow velocity reserve measurement by echo Doppler is a simple and easy technique. It is available in the echo laboratory as well as in the outpatient clinic, and can be used as an alternative examination to screen for significant coronary stenosis in patients with stable angina. Moreover, physiological information provided by coronary flow velocity reserve can be used in combination with other imaging modalities that can provide anatomical information of the coronary arteries such as coronary computed tomography or coronary angiography. Coronary flow velocity in patients with acute coronary syndrome (ACS) enables rapid noninvasive differentiation of TIMI-III from TIMI-II coronary reperfusion before emergency coronary intervention. Transthoracic coronary flow detection by echo Doppler contributes to the assessment of the coronary reperfusion status in the emergency room for patients with ACS, prior to invasive coronary angiography.
Literature
1.
go back to reference Voci P, Testa G, Plaustro G. Imaging of the distal left anterior descending coronary artery by transthoracic color-Doppler echocardiography. Am J Cardiol. 1998;81:74G–8G.CrossRefPubMed Voci P, Testa G, Plaustro G. Imaging of the distal left anterior descending coronary artery by transthoracic color-Doppler echocardiography. Am J Cardiol. 1998;81:74G–8G.CrossRefPubMed
2.
go back to reference Hozumi T, Yoshida K, Akasaka T, Asami Y, Ogata Y, Takagi T, Kaji S, Kawamoto T, Ueda Y, Morioka S. Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: comparison with invasive technique. J Am Coll Cardiol. 1998;32:1251–9.CrossRefPubMed Hozumi T, Yoshida K, Akasaka T, Asami Y, Ogata Y, Takagi T, Kaji S, Kawamoto T, Ueda Y, Morioka S. Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: comparison with invasive technique. J Am Coll Cardiol. 1998;32:1251–9.CrossRefPubMed
3.
go back to reference Voci P, Pizzuto F, Mariano E, Puddu PE, Sardella G, Romeo F. Usefulness of coronary flow reserve measured by transthoracic coronary Doppler ultrasound to detect severe left anterior descending coronary artery stenosis. Am J Cardiol. 2003;92:1320–4.CrossRefPubMed Voci P, Pizzuto F, Mariano E, Puddu PE, Sardella G, Romeo F. Usefulness of coronary flow reserve measured by transthoracic coronary Doppler ultrasound to detect severe left anterior descending coronary artery stenosis. Am J Cardiol. 2003;92:1320–4.CrossRefPubMed
4.
go back to reference Ueno Y, Nakamura Y, Takashima H, Kinoshita M, Soma A. Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the right coronary artery by transthoracic Doppler echocardiography: comparison with intracoronary Doppler guidewire. J Am Soc Echocardiogr. 2002;15:1074–9.CrossRefPubMed Ueno Y, Nakamura Y, Takashima H, Kinoshita M, Soma A. Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the right coronary artery by transthoracic Doppler echocardiography: comparison with intracoronary Doppler guidewire. J Am Soc Echocardiogr. 2002;15:1074–9.CrossRefPubMed
5.
go back to reference Watanabe H, Hozumi T, Hirata K, Otsuka R, Tokai K, Muro T, Shimada K, Yoshiyama M, Takeuchi K, Yoshikawa J. Noninvasive coronary flow velocity reserve measurement in the posterior descending coronary artery for detecting coronary stenosis in the right coronary artery using contrast-enhanced transthoracic Doppler echocardiography. Echocardiography. 2004;21:225–33.CrossRefPubMed Watanabe H, Hozumi T, Hirata K, Otsuka R, Tokai K, Muro T, Shimada K, Yoshiyama M, Takeuchi K, Yoshikawa J. Noninvasive coronary flow velocity reserve measurement in the posterior descending coronary artery for detecting coronary stenosis in the right coronary artery using contrast-enhanced transthoracic Doppler echocardiography. Echocardiography. 2004;21:225–33.CrossRefPubMed
6.
go back to reference Fujimoto K, Watanabe H, Hozumi T, Otsuka R, Hirata K, Yamagishi H, Yoshiyama M, Yoshikawa J. New noninvasive diagnosis of myocardial ischemia of the left circumflex coronary artery using coronary flow reserve measurement by transthoracic Doppler echocardiography: comparison with thallium-201 single photon emission computed tomography. J Cardiol. 2004;43:109–16.PubMed Fujimoto K, Watanabe H, Hozumi T, Otsuka R, Hirata K, Yamagishi H, Yoshiyama M, Yoshikawa J. New noninvasive diagnosis of myocardial ischemia of the left circumflex coronary artery using coronary flow reserve measurement by transthoracic Doppler echocardiography: comparison with thallium-201 single photon emission computed tomography. J Cardiol. 2004;43:109–16.PubMed
7.
go back to reference Takeuchi M, Lodato JA, Furlong KT, Lang RM, Yoshikawa J. Feasibility of measuring coronary flow velocity and reserve in the left anterior descending coronary artery by transthoracic Doppler echocardiography in a relatively obese American population. Echocardiography. 2005;22:225–32.CrossRefPubMed Takeuchi M, Lodato JA, Furlong KT, Lang RM, Yoshikawa J. Feasibility of measuring coronary flow velocity and reserve in the left anterior descending coronary artery by transthoracic Doppler echocardiography in a relatively obese American population. Echocardiography. 2005;22:225–32.CrossRefPubMed
8.
go back to reference Higashiue S, Watanabe H, Yokoi Y, Takeuchi K, Yoshikawa J. Simple detection of severe coronary stenosis using transthoracic Doppler echocardiography at rest. Am J Cardiol. 2001;87:1064–8.CrossRefPubMed Higashiue S, Watanabe H, Yokoi Y, Takeuchi K, Yoshikawa J. Simple detection of severe coronary stenosis using transthoracic Doppler echocardiography at rest. Am J Cardiol. 2001;87:1064–8.CrossRefPubMed
9.
go back to reference Daimon M, Watanabe H, Yamagishi H, Kuwabara Y, Hasegawa R, Toyoda T, Yoshida K, Yoshikawa J, Komuro I. Physiologic assessment of coronary artery stenosis without stress tests: noninvasive analysis of phasic flow characteristics by transthoracic Doppler echocardiography. J Am Soc Echocardiogr. 2005;18:949–55.CrossRefPubMed Daimon M, Watanabe H, Yamagishi H, Kuwabara Y, Hasegawa R, Toyoda T, Yoshida K, Yoshikawa J, Komuro I. Physiologic assessment of coronary artery stenosis without stress tests: noninvasive analysis of phasic flow characteristics by transthoracic Doppler echocardiography. J Am Soc Echocardiogr. 2005;18:949–55.CrossRefPubMed
10.
go back to reference Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34:48–55.CrossRefPubMed Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34:48–55.CrossRefPubMed
11.
go back to reference Hozumi T, Yoshida K, Ogata Y, Akasaka T, Asami Y, Takagi T, Morioka S. Noninvasive assessment of significant left anterior descending coronary artery stenosis by coronary flow velocity reserve with transthoracic color Doppler echocardiography. Circulation. 1998;97:1557–62.CrossRefPubMed Hozumi T, Yoshida K, Ogata Y, Akasaka T, Asami Y, Takagi T, Morioka S. Noninvasive assessment of significant left anterior descending coronary artery stenosis by coronary flow velocity reserve with transthoracic color Doppler echocardiography. Circulation. 1998;97:1557–62.CrossRefPubMed
12.
go back to reference Takeuchi M, Ogawa K, Wake R, Takise H, Miyazaki C, Otani S, Sakamoto K, Yoshikawa J. Measurement of coronary flow velocity reserve in the posterior descending coronary artery by contrast-enhanced transthoracic Doppler echocardiography. J Am Soc Echocardiogr. 2004;17:21–7.CrossRefPubMed Takeuchi M, Ogawa K, Wake R, Takise H, Miyazaki C, Otani S, Sakamoto K, Yoshikawa J. Measurement of coronary flow velocity reserve in the posterior descending coronary artery by contrast-enhanced transthoracic Doppler echocardiography. J Am Soc Echocardiogr. 2004;17:21–7.CrossRefPubMed
13.
go back to reference Michelsen MM, Pena A, Mygind ND, Frestad D, Gustafsson I, Hansen HS, Kastrup J, Bech J, Host N, Prescott E. Coronary flow velocity reserve assessed by transthoracic Doppler: the iPOWER study: factors influencing feasibility and quality. J Am Soc Echocardiogr. 2016;29:709–16.CrossRefPubMed Michelsen MM, Pena A, Mygind ND, Frestad D, Gustafsson I, Hansen HS, Kastrup J, Bech J, Host N, Prescott E. Coronary flow velocity reserve assessed by transthoracic Doppler: the iPOWER study: factors influencing feasibility and quality. J Am Soc Echocardiogr. 2016;29:709–16.CrossRefPubMed
14.
go back to reference Pizzuto F, Voci P, Mariano E, Puddu PE, Chiavari PA, Romeo F. Noninvasive coronary flow reserve assessed by transthoracic coronary Doppler ultrasound in patients with left anterior descending coronary artery stents. Am J Cardiol. 2003;91:522–6.CrossRefPubMed Pizzuto F, Voci P, Mariano E, Puddu PE, Chiavari PA, Romeo F. Noninvasive coronary flow reserve assessed by transthoracic coronary Doppler ultrasound in patients with left anterior descending coronary artery stents. Am J Cardiol. 2003;91:522–6.CrossRefPubMed
15.
go back to reference Matsumura Y, Hozumi T, Watanabe H, Fujimoto K, Sugioka K, Takemoto Y, Shimada K, Muro T, Yoshiyama M, Takeuchi K, Yoshikawa J. Cut-off value of coronary flow velocity reserve by transthoracic Doppler echocardiography for diagnosis of significant left anterior descending artery stenosis in patients with coronary risk factors. Am J Cardiol. 2003;92:1389–93.CrossRefPubMed Matsumura Y, Hozumi T, Watanabe H, Fujimoto K, Sugioka K, Takemoto Y, Shimada K, Muro T, Yoshiyama M, Takeuchi K, Yoshikawa J. Cut-off value of coronary flow velocity reserve by transthoracic Doppler echocardiography for diagnosis of significant left anterior descending artery stenosis in patients with coronary risk factors. Am J Cardiol. 2003;92:1389–93.CrossRefPubMed
16.
go back to reference Saraste M, Vesalainen RK, Ylitalo A, Saraste A, Koskenvuo JW, Toikka JO, Vaittinen MA, Hartiala JJ, Airaksinen KE. Transthoracic Doppler echocardiography as a noninvasive tool to assess coronary artery stenoses—a comparison with quantitative coronary angiography. J Am Soc Echocardiogr. 2005;18:679–85.CrossRefPubMed Saraste M, Vesalainen RK, Ylitalo A, Saraste A, Koskenvuo JW, Toikka JO, Vaittinen MA, Hartiala JJ, Airaksinen KE. Transthoracic Doppler echocardiography as a noninvasive tool to assess coronary artery stenoses—a comparison with quantitative coronary angiography. J Am Soc Echocardiogr. 2005;18:679–85.CrossRefPubMed
17.
go back to reference Hozumi T, Yoshida K, Akasaka T, Asami Y, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Yoshikawa J. Value of acceleration flow and the prestenotic to stenotic coronary flow velocity ratio by transthoracic color Doppler echocardiography in noninvasive diagnosis of restenosis after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 2000;35:164–8.CrossRefPubMed Hozumi T, Yoshida K, Akasaka T, Asami Y, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Yoshikawa J. Value of acceleration flow and the prestenotic to stenotic coronary flow velocity ratio by transthoracic color Doppler echocardiography in noninvasive diagnosis of restenosis after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 2000;35:164–8.CrossRefPubMed
18.
go back to reference Watanabe N, Akasaka T, Yamaura Y, Wada N, Akiyama M, Neishi Y, Koyama Y, Yoshida K. Transthoracic Doppler echocardiography can detect coronary flow signals through the coronary stents: noninvasive direct visualization of in-stent coronary restenosis? J Echocardiogr. 2004;2:61–7.CrossRef Watanabe N, Akasaka T, Yamaura Y, Wada N, Akiyama M, Neishi Y, Koyama Y, Yoshida K. Transthoracic Doppler echocardiography can detect coronary flow signals through the coronary stents: noninvasive direct visualization of in-stent coronary restenosis? J Echocardiogr. 2004;2:61–7.CrossRef
19.
go back to reference Holte E, Vegsundvag J, Hegbom K, Hole T, Wiseth R. Transthoracic Doppler for detection of stenoses in the three main coronary arteries by use of stenotic to prestenotic velocity ratio and aliased coronary flow. Eur Heart J Cardiovasc Imaging. 2015;16:1323–30.PubMed Holte E, Vegsundvag J, Hegbom K, Hole T, Wiseth R. Transthoracic Doppler for detection of stenoses in the three main coronary arteries by use of stenotic to prestenotic velocity ratio and aliased coronary flow. Eur Heart J Cardiovasc Imaging. 2015;16:1323–30.PubMed
20.
go back to reference Watanabe N, Akasaka T, Yamaura Y, Akiyama M, Koyama Y, Kamiyama N, Neishi Y, Kaji S, Saito Y, Yoshida K. Noninvasive detection of total occlusion of the left anterior descending coronary artery with transthoracic Doppler echocardiography. J Am Coll Cardiol. 2001;38:1328–32.CrossRefPubMed Watanabe N, Akasaka T, Yamaura Y, Akiyama M, Koyama Y, Kamiyama N, Neishi Y, Kaji S, Saito Y, Yoshida K. Noninvasive detection of total occlusion of the left anterior descending coronary artery with transthoracic Doppler echocardiography. J Am Coll Cardiol. 2001;38:1328–32.CrossRefPubMed
21.
go back to reference Hirata K, Watanabe H, Hozumi T, Tokai K, Otsuka R, Fujimoto K, Shimada K, Muro T, Yoshiyama M, Yoshikawa J. Simple detection of occluded coronary artery using retrograde flow in septal branch and left anterior descending coronary artery by transthoracic Doppler echocardiography at rest. J Am Soc Echocardiogr. 2004;17:108–13.CrossRefPubMed Hirata K, Watanabe H, Hozumi T, Tokai K, Otsuka R, Fujimoto K, Shimada K, Muro T, Yoshiyama M, Yoshikawa J. Simple detection of occluded coronary artery using retrograde flow in septal branch and left anterior descending coronary artery by transthoracic Doppler echocardiography at rest. J Am Soc Echocardiogr. 2004;17:108–13.CrossRefPubMed
22.
go back to reference Otsuka R, Watanabe H, Hirata K, Tokai K, Muro T, Hozumi T, Yoshiyama M, Yoshikawa J. A novel technique to detect total occlusion in the right coronary artery using retrograde flow by transthoracic Doppler echocardiography. J Am Soc Echocardiogr. 2005;18:704–9.CrossRefPubMed Otsuka R, Watanabe H, Hirata K, Tokai K, Muro T, Hozumi T, Yoshiyama M, Yoshikawa J. A novel technique to detect total occlusion in the right coronary artery using retrograde flow by transthoracic Doppler echocardiography. J Am Soc Echocardiogr. 2005;18:704–9.CrossRefPubMed
23.
go back to reference Lee S, Otsuji Y, Minagoe S, Hamasaki S, Toyonaga K, Negishi M, Tsurugida M, Toda H, Tei C. Noninvasive evaluation of coronary reperfusion by transthoracic Doppler echocardiography in patients with anterior acute myocardial infarction before coronary intervention. Circulation. 2003;108:2763–8.CrossRefPubMed Lee S, Otsuji Y, Minagoe S, Hamasaki S, Toyonaga K, Negishi M, Tsurugida M, Toda H, Tei C. Noninvasive evaluation of coronary reperfusion by transthoracic Doppler echocardiography in patients with anterior acute myocardial infarction before coronary intervention. Circulation. 2003;108:2763–8.CrossRefPubMed
24.
go back to reference Yamamuro A, Akasaka T, Tamita K, Yamabe K, Katayama M, Takagi T, Morioka S. Coronary flow velocity pattern immediately after percutaneous coronary intervention as a predictor of complications and in-hospital survival after acute myocardial infarction. Circulation. 2002;106:3051–6.CrossRefPubMed Yamamuro A, Akasaka T, Tamita K, Yamabe K, Katayama M, Takagi T, Morioka S. Coronary flow velocity pattern immediately after percutaneous coronary intervention as a predictor of complications and in-hospital survival after acute myocardial infarction. Circulation. 2002;106:3051–6.CrossRefPubMed
25.
go back to reference Hozumi T, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Akasaka T, Homma S, Yoshida K, Yoshikawa J. Coronary flow velocity analysis during short term follow up after coronary reperfusion: use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction. Heart. 2003;89:1163–8.CrossRefPubMedPubMedCentral Hozumi T, Kanzaki Y, Ueda Y, Yamamuro A, Takagi T, Akasaka T, Homma S, Yoshida K, Yoshikawa J. Coronary flow velocity analysis during short term follow up after coronary reperfusion: use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction. Heart. 2003;89:1163–8.CrossRefPubMedPubMedCentral
26.
go back to reference Shintani Y, Ito H, Iwakura K, Kawano S, Tanaka K, Masuyama T, Hori M, Fujii K. Usefulness of impairment of coronary microcirculation in predicting left ventricular dilation after acute myocardial infarction. Am J Cardiol. 2004;93:974–8.CrossRefPubMed Shintani Y, Ito H, Iwakura K, Kawano S, Tanaka K, Masuyama T, Hori M, Fujii K. Usefulness of impairment of coronary microcirculation in predicting left ventricular dilation after acute myocardial infarction. Am J Cardiol. 2004;93:974–8.CrossRefPubMed
27.
go back to reference Tani T, Tanabe K, Kitai T, Yamane T, Kureha F, Katayama M, Tamita K, Kaji S, Oda T, Ehara N, Kinoshita M, Yamamuro A, Morioka S, Kihara Y. Detection of severe stenosis and total occlusion in the left anterior descending coronary artery with transthoracic Doppler echocardiography in the emergency room. Echocardiography. 2009;26:15–20.CrossRefPubMed Tani T, Tanabe K, Kitai T, Yamane T, Kureha F, Katayama M, Tamita K, Kaji S, Oda T, Ehara N, Kinoshita M, Yamamuro A, Morioka S, Kihara Y. Detection of severe stenosis and total occlusion in the left anterior descending coronary artery with transthoracic Doppler echocardiography in the emergency room. Echocardiography. 2009;26:15–20.CrossRefPubMed
Metadata
Title
Noninvasive assessment of coronary blood flow by transthoracic Doppler echocardiography: basic to practical use in the emergency room
Author
Nozomi Watanabe
Publication date
01-06-2017
Publisher
Springer Japan
Published in
Journal of Echocardiography / Issue 2/2017
Print ISSN: 1349-0222
Electronic ISSN: 1880-344X
DOI
https://doi.org/10.1007/s12574-016-0324-2

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