Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary microvascular dysfunction: The iPOWER study. (1st February 2017)

• Record Type: Journal Article
• Authors: Michelsen, Marie Mide; Mygind, Naja Dam; Pena, Adam; Olsen, Rasmus Huan; Christensen, Thomas Emil; Ghotbi, Adam Ali; Hasbak, Philip; Kjaer, Andreas; Gustafsson, Ida; Hansen, Peter Riis; Hansen, Henrik Steen; Høst, Nis; Kastrup, Jens; Prescott, Eva
• Is Part Of: International journal of cardiology. Volume 228(2017)
• Page Start: 435
• Page End: 443
• Publication Date: 2017-02-01
• Subjects: 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; Coronary flow velocity reserve -- Myocardial blood flow reserve -- Reproducibility -- Repeatability -- Microvascular angina pectoris -- Myocardial blood flow; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.11.004
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: 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. Methods: From 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. Results: MBFR 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. Conclusion: CFVR 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.