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The Additive Diagnostic Role of Coronary Flow Reserve in Noninvasive Evaluation of Coronary Stenosis on Left Descending Artery Previously Detected by Multislice Computed Tomography
Author(s) -
Mladenovic Zorica,
DjordjevicDikic Ana,
Tavciovski Dragan,
Angelkov Andjelka Ristic,
Jovic Zoran,
Djuric Predrag
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12041
Subject(s) - multislice computed tomography , multislice , stenosis , medicine , cardiology , fractional flow reserve , computed tomography , radiology , artery , coronary arteries , coronary angiography , myocardial infarction
Purpose: Multislice computed coronary angiography ( MSCT ) provides valuable morphological information about coronary artery disease, but precise quantification of coronary stenosis remains difficult. Transthoracic color D oppler echocardiography ( TDE ) gives a new insight into the functional significance of coronary luminal narrowing. We have tried to assess the additive value of coronary flow reserve ( CFR ) determined by TDE over MSCT in prediction of a significant stenosis on the left anterior descending artery ( LAD ) using the invasive coronary angiography ( ICA ) as a reference method. Methods: This prospective study included 63 patients in stable cardiac status with previously detected atherosclerotic lesions on LAD by MSCT . CFR assessment by TDE with adenosine infusion was obtained to all patients (feasibility was 96.92%). CFR was determined as ratio between the peak diastolic flow velocity during adenosine infusion and at basal condition, a cutoff value indicating significant stenosis was <2. ICA was preformed to all patients 24–48 hours after CFR . Results: MSCT had sensitivity of 86.36%, specificity 53.66%, positive predictive value 50.00%, negative predictive value 88.00%, and diagnostic accuracy of 65.07% in detection of significant LAD stenosis. CFR had sensitivity 81.81%, specificity 97.06%, positive predictive value 94.74%, negative predictive value 89.19%, and diagnostic accuracy of 91.07%. When the results of both methods were agreed diagnostic accuracy was improved to 92.72%. Conclusion: Additional assessment of CFR by TDE increase diagnostic accuracy of MSCT angiography in detection of significant coronary artery lesions.