[The role of transesophageal dopplerographical assessment of coronary reserve in coronary sinus in diagnosis of hemodynamically significant left coronary artery stenoses].

AIM

To assess the role of estimation of coronary reserve in coronary sinus by transesophageal doppler during dipyridamole stress test for diagnosis of hemodynamically significant left coronary artery stenoses.

MATERIAL

Patients with angiographically proven left coronary artery stenoses (n=29) and 25 healthy volunteers.

METHODS

Coronary reserve was calculated as 1) ratio of peak to basal diastolic coronary flow velocity (V(p)CR), and 2) ratio of volume coronary blood flow velocity before and during hyperemia (VBF CR). Coronary reserve <2 was considered decreased.

RESULTS

Compared with healthy subjects patients with coronary heart desease had significantly lower V(p)CR (1.67+/-0.44 and 2.56+/-0.87, respectively, p<0.001) and VBF CR (2.42+/-1.37 and 5.53+/-3.65, respectively, p<0.001). Sensitivity and specificity of coronary reserve below 2 for diagnosis of left coronary artery stenoses was 72 and 72%, respectively, for V(p)CR, and 49 and 96%, respectively, for VBF CR. VBF CR below 2 was a marker of severe double vessel left coronary artery disease. V(p)CR <2 was associated with single vessel stenoses within left coronary artery system.

CONCLUSION

The use of evaluation of coronary reserve by transesophageal dopplerography for diagnosis of left coronary artery stenoses is methodologically correct. Level of coronary reserve in coronary sinus can be considered an integral parameter characterizing total left coronary artery atherosclerotic damage.