Using transthoracic Doppler echocardiography to diagnose reduced coronary flow velocity reserve in the posterior descending coronary artery in children with elevated right ventricular pressure.

BACKGROUND Advances in transthoracic Doppler echocardiography enable noninvasive measurements of coronary flow velocity and coronary flow velocity reserve (CFVR) in the posterior descending coronary artery (PD). METHODS AND RESULTS To evaluate CFVR in the PD of children with elevated right ventricular (RV) pressure, 19 children with RV pressure overload and 13 age-matched controls with normal RV pressure were studied using transthoracic Doppler echocardiography. Average peak flow velocity (APV) was measured at rest and in hyperemic conditions (intravenous administration of adenosine of 0.16 mg.kg(-1).min(-1)). Compared with controls, the PD CFVR was significantly reduced in the patients with elevated RV pressure (1.87+/-0.42 vs 2.49+/-0.55, p<0.01) because their mean baseline APV was significantly greater (27+/-6 vs 19+/-4 cm/s, p<0.01), although hyperemic APV was not significantly different (49+/-10 vs 48+/-14 cm/s, p=NS). CONCLUSIONS PD CFVR is limited in patients with elevated RV pressure because of elevation of the baseline resting flow velocity.

[1]  C. Warnes.  Transposition of the great arteries. , 2006, Circulation.

[2]  M. Hori,et al.  Coronary flow reserve by contrast enhanced transesophageal coronary sinus Doppler measurements can evaluate diabetic microvascular dysfunction. , 2006, Circulation journal : official journal of the Japanese Circulation Society.

[3]  H. Kasanuki,et al.  Non-invasive assessment of coronary arterial tone using trans-thoracic Doppler echocardiography. , 2006, Circulation journal : official journal of the Japanese Circulation Society.

[4]  Y. Neishi,et al.  Assessment of coronary microcirculation in patients with takotsubo-like left ventricular dysfunction. , 2005, Circulation journal : official journal of the Japanese Circulation Society.

[5]  N. Tamaki,et al.  Quantitative assessment of regional myocardial flow reserve using tc-99m-sestamibi imaging. , 2005, Circulation journal : official journal of the Japanese Circulation Society.

[6]  E. Foster,et al.  Demonstration of coronary artery flow using transthoracic Doppler echocardiography. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[7]  H. Lethen,et al.  Validation of noninvasive assessment of coronary flow velocity reserve in the right coronary artery. A comparison of transthoracic echocardiographic results with intracoronary Doppler flow wire measurements. , 2003, European heart journal.

[8]  K. Harada,et al.  Noninvasive visualization and measurement of posterior descending coronary artery flow velocity by transthoracic Doppler echocardiography in normal children. , 2003, American Journal of Cardiology.

[9]  S. Hiraishi,et al.  Transthoracic Doppler assessment of coronary flow velocity reserve in children with Kawasaki disease: comparison with coronary angiography and thallium-201 imaging. , 2002, Journal of the American College of Cardiology.

[10]  F. Romeo,et al.  Measurement of coronary flow reserve in the anterior and posterior descending coronary arteries by transthoracic Doppler ultrasound. , 2002, The American journal of cardiology.

[11]  H. Lethen,et al.  Transthoracic echocardiographic visualization of coronary artery blood flow and assessment of coronary flow reserve in the right coronary artery: a first report of 3 patients. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[12]  H. Lamb,et al.  Exercise MR imaging in the assessment of pulmonary regurgitation and biventricular function in patients after tetralogy of fallot repair. , 2002, Radiology.

[13]  M. Kinoshita,et al.  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. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[14]  O. Muzik,et al.  Myocardial flow reserve in patients with a systemic right ventricle after atrial switch repair. , 2001, Journal of the American College of Cardiology.

[15]  P. Voci,et al.  Imaging of the posterior descending coronary artery. The last frontier in echocardiography. , 2001, Italian heart journal : official journal of the Italian Federation of Cardiology.

[16]  N. Watanabe,et al.  Effects of heart rate and right ventricular pressure on right coronary arterial flow and its systolic versus diastolic distribution in a variety of congenital heart diseases in children , 2000, Pediatrics international : official journal of the Japan Pediatric Society.

[17]  E. Jaeggi,et al.  Role of ischemia and infarction in late right ventricular dysfunction after atrial repair of transposition of the great arteries. , 2000, Journal of the American College of Cardiology.

[18]  T. Kawamoto,et al.  Restricted coronary flow reserve in patients with mitral regurgitation improves after mitral reconstructive surgery. , 1998, Journal of the American College of Cardiology.

[19]  I. Kallikazaros,et al.  Effects of pulmonary balloon valvuloplasty on right coronary artery blood flow in pulmonary valve stenosis. , 1998, The American journal of cardiology.

[20]  T. Graham,et al.  Ventricular performance in congenital heart disease. , 1991, Circulation.

[21]  R. Wilson,et al.  Interstudy variability of coronary flow reserve. Influence of heart rate, arterial pressure, and ventricular preload. , 1990, Circulation.

[22]  A. Rudolph,et al.  The effects of changes in heart rate and aortic systolic pressure on left ventricular myocardial oxygen consumption in lambs. , 1989, Journal of developmental physiology.

[23]  R. Sade.  Transposition of the Great Arteries , 1988 .

[24]  A. Nitenberg,et al.  Coronary flow and resistance reserve in patients with chronic aortic regurgitation, angina pectoris and normal coronary arteries. , 1988, Journal of the American College of Cardiology.

[25]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[26]  A. Pichard,et al.  Coronary vascular reserve in left ventricular hypertrophy secondary to chronic aortic regurgitation. , 1983, The American journal of cardiology.

[27]  M. Fishbein,et al.  Effects of exerimental right ventricular hypertrophy on myocardial blood flow in conscious dogs. , 1979, The Journal of clinical investigation.

[28]  R. Patterson,et al.  Phasic Right Coronary Artery Blood Flow in Conscious Dogs with Normal and Elevated Right Ventricular Pressures , 1976, Circulation research.

[29]  Y. Wang,et al.  Hemodynamic correlates of myocardial oxygen consumption during upright exercise. , 1972, Journal of applied physiology.

[30]  G. Ross.  Blood flow in the right coronary artery of the dog. , 1967, Cardiovascular research.

[31]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[32]  M. Takeuchi,et al.  Measurement of coronary flow velocity reserve in the posterior descending coronary artery by contrast-enhanced transthoracic Doppler echocardiography. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[33]  J. Corbett,et al.  Resting coronary flow and coronary flow reserve in human infants after repair or palliation of congenital heart defects as measured by positron emission tomography. , 1998, The Journal of thoracic and cardiovascular surgery.

[34]  W. Kübler,et al.  Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. , 1984, Circulation.

[35]  C. E. Cross.  Right ventricular pressure and coronary flow. , 1962, The American journal of physiology.