Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary microvascular dysfunction: The iPOWER study

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• 作者：Marie Mide Michelsen^a ; ¹ ; ^{marie.mide.michelsen@regionh.dk} ; Naja Dam Mygind^b ; ¹ ; Adam Pena^c ; Rasmus Huan Olsen^a ; Thomas Emil Christensen^b ; Adam Ali Ghotbi^d ; Philip Hasbak^d ; Andreas Kjaer^d ; Ida Gustafsson^e ; Peter Riis Hansen^c ; Henrik Steen Hansen^f ; Nis Hø ; st^a ; Jens Kastrup^b ; Eva Prescott^a
• 关键词：TTDE ; Transthoracic Doppler echocardiography ; CFVR ; Coronary flow velocity reserve ; PET ; Positron emission tomography ; MBFR ; Myocardial blood flow reserve ; CMD ; Coronary microvascular dysfunction ; CAD ; Coronary artery disease ; CAG ; Coronary angiography ; LAD ; Left anterior descending artery ; MBF ; Myocardial blood flow ; CFV ; coronary flow velocity
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：435-443
• 全文大小：1103 K
• 卷排序：228

文摘

Coronary microvascular function can be assessed by transthoracic Doppler echocardiography as a coronary flow velocity reserve (TTDE CFVR) and by positron emission tomography as a myocardial blood flow reserve (PET MBFR). PET MBFR is regarded the noninvasive reference standard for measuring coronary microvascular function but has limited availability. We compared TTDE CFVR with PET MBFR in women with angina pectoris and no obstructive coronary artery disease and assessed repeatability of TTDE CFVR.MethodsFrom a cohort of women with angina and no obstructive coronary artery stenosis at invasive coronary angiography, TTDE CFVR by dipyridamole induced stress and MBFR by rubidium-82 PET with adenosine was successfully measured in 107 subjects. Repeatability of TTDE CFVR was assessed in 10 symptomatic women and in 10 healthy individuals.ResultsMBFR was systematically higher than CFVR. Median MBFR (interquartile range, IQR) was 2.68 (2.29–3.10) and CFVR (IQR) was 2.31 (1.89–2.72). Pearson's correlation coefficient was 0.36 (p < 0.01). Limits of agreement (2·standard deviation) assessed by the Bland–Altman (confidence interval, CI) method was 1.49 (1.29;1.69) and unaffected by time-interval between examinations. Results were similar when adjusting for rate pressure product or focusing on perfusion of the left anterior descending artery region. Limits of agreement (CI) for repeated CFVR in 10 healthy individuals and in 10 women with angina was 0.44 (0.21;0.68) and 0.48 (0.22; 0.74), respectively.ConclusionCFVR had a good repeatability, but the agreement between CFVR and MBFR was modest. Divergence could be due to methodology differences; TTDE estimates flow velocities whereas PET estimates myocardial blood flow.