Marie M Michelsen1, Adam Pena2, Naja D Mygind3, Daria Frestad4, Ida Gustafsson4, Henrik S Hansen5, Jens Kastrup3, Jan Bech2, Nis Høst6, Eva Prescott6. 1. Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: marie.mide.michelsen@regionh.dk. 2. Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. 3. Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 4. Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. 5. Department of Cardiology, Odense University Hospital, Odense, Denmark. 6. Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Abstract
BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography is a noninvasive measure of microvascular function, but it has not achieved widespread use, mainly because of concerns of validity and feasibility. The aim of this study was to describe the feasibility and factors associated with the quality of CFVR obtained in a large prospective study of women suspected of having microvascular disease. METHODS: Women with angina-like chest pain and no obstructive coronary artery disease on coronary angiography (<50% stenosis) were consecutively examined by transthoracic Doppler echocardiography of the left anterior descending coronary artery to measure CFVR (n = 947). Quality was evaluated on the basis of (1) identification of the left anterior descending coronary artery, (2) maintained probe position throughout the examination, (3) visibility and configuration of the left anterior descending coronary artery in two-dimensional color Doppler mode, and (4) gradual, consistent increases of characteristic, well-defined flow velocity curves in pulsed-wave mode. RESULTS: The mean age (SD) was 62.1 ± 9.7 years. On the basis of the evaluations, patients were divided into four groups according to quality score: nonfeasible (n = 28 [3%]), low quality (n = 80 [8%]), medium quality (n = 451 [48%]), and high quality (n = 388 [41%]). Quality score was associated with diabetes (P < .01), body mass index (P = .02), waist circumference (P = .05), nonsignificant atherosclerosis on coronary angiography (P = .03), and operator experience (P < .01). Low examination quality was associated with lower CFVR (P = .03), also after multivariate adjustment. CONCLUSIONS: Transthoracic Doppler echocardiographic measurement of CFVR is highly feasible and of good quality in experienced hands. However, CFVR is possibly underestimated when examination quality is low. Awareness of pitfalls and potential bias may improve the validity and interpretation of the measures obtained.
BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography is a noninvasive measure of microvascular function, but it has not achieved widespread use, mainly because of concerns of validity and feasibility. The aim of this study was to describe the feasibility and factors associated with the quality of CFVR obtained in a large prospective study of women suspected of having microvascular disease. METHODS:Women with angina-like chest pain and no obstructive coronary artery disease on coronary angiography (<50% stenosis) were consecutively examined by transthoracic Doppler echocardiography of the left anterior descending coronary artery to measure CFVR (n = 947). Quality was evaluated on the basis of (1) identification of the left anterior descending coronary artery, (2) maintained probe position throughout the examination, (3) visibility and configuration of the left anterior descending coronary artery in two-dimensional color Doppler mode, and (4) gradual, consistent increases of characteristic, well-defined flow velocity curves in pulsed-wave mode. RESULTS: The mean age (SD) was 62.1 ± 9.7 years. On the basis of the evaluations, patients were divided into four groups according to quality score: nonfeasible (n = 28 [3%]), low quality (n = 80 [8%]), medium quality (n = 451 [48%]), and high quality (n = 388 [41%]). Quality score was associated with diabetes (P < .01), body mass index (P = .02), waist circumference (P = .05), nonsignificant atherosclerosis on coronary angiography (P = .03), and operator experience (P < .01). Low examination quality was associated with lower CFVR (P = .03), also after multivariate adjustment. CONCLUSIONS: Transthoracic Doppler echocardiographic measurement of CFVR is highly feasible and of good quality in experienced hands. However, CFVR is possibly underestimated when examination quality is low. Awareness of pitfalls and potential bias may improve the validity and interpretation of the measures obtained.
Authors: Malin Nilsson; Kira Bang Bové; Elena Suhrs; Thomas Hermann; Sten Madsbad; Jens Juul Holst; Eva Prescott; Mette Zander Journal: Int J Cardiol Heart Vasc Date: 2019-01-29
Authors: Marie Mide Michelsen; Anna Bay Rask; Elena Suhrs; Kristoffer Flintholm Raft; Nis Høst; Eva Prescott Journal: PLoS One Date: 2018-06-08 Impact factor: 3.240
Authors: Kira Bang Bove; Marie M Michelsen; Jakob Schroder; Hannah Elena Suhrs; Daria F Bechsgaard; Naja Dam Mygind; Ahmed Aziz; Jens Kastrup; Ida Gustafsson; Eva Prescott Journal: Open Heart Date: 2021-01
Authors: Kira Bang Bove; Malin Nilsson; Lene Rørholm Pedersen; Nicolai Mikkelsen; Hannah Elena Suhrs; Arne Astrup; Eva Prescott Journal: PLoS One Date: 2020-11-05 Impact factor: 3.240