Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary microvascular dysfunction: The iPOWER study

TY - JOUR

T1 - Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary microvascular dysfunction

T2 - The iPOWER study

AU - Michelsen, Marie Mide

AU - Mygind, Naja Dam

AU - Pena, Adam

AU - Olsen, Rasmus Huan

AU - Christensen, Thomas Emil

AU - Ghotbi, Adam Ali

AU - Hasbak, Philip

AU - Kjaer, Andreas

AU - Gustafsson, Ida

AU - Hansen, Peter Riis

AU - Hansen, Henrik Steen

AU - Høst, Nis

AU - Kastrup, Jens

AU - Prescott, Eva

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

AB - 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.

U2 - 10.1016/j.ijcard.2016.11.004

DO - 10.1016/j.ijcard.2016.11.004

M3 - Journal article

C2 - 27870973

SN - 0167-5273

VL - 228

SP - 435

EP - 443

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -