Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality

Trond M Michelsen, Adam Pena, Naja Dam Mygind, D. Frestad, I. Gustafsson, H. S. Hansen, J. Kastrup, J Bech, N. Høst, E. Prescott

Research output: Contribution to journalJournal articleResearchpeer-review

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.
Original languageEnglish
JournalJournal of the American Society of Echocardiography
Volume29
Issue number7
Pages (from-to)709-716
ISSN0894-7317
DOIs
Publication statusPublished - 2016

Fingerprint

Doppler Echocardiography
Coronary Angiography
Echocardiography
Coronary Artery Disease
Pathologic Constriction
Body Mass Index
Color
Prospective Studies

Keywords

  • Coronary flow velocity reserve Transthoracic Doppler echocardiography Coronary microvascular function Feasibility Quality intracoronary doppler prognostic value stress echocardiography microvascular disease artery-disease angiography tomography validation risk Cardiovascular System & Cardiology

Cite this

Michelsen, Trond M ; Pena, Adam ; Mygind, Naja Dam ; Frestad, D. ; Gustafsson, I. ; Hansen, H. S. ; Kastrup, J. ; Bech, J ; Høst, N. ; Prescott, E. / Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality. In: Journal of the American Society of Echocardiography. 2016 ; Vol. 29, No. 7. pp. 709-716.
@article{40725de0330b4645bcb1aa3277f65767,
title = "Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality",
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.",
keywords = "Coronary flow velocity reserve Transthoracic Doppler echocardiography Coronary microvascular function Feasibility Quality intracoronary doppler prognostic value stress echocardiography microvascular disease artery-disease angiography tomography validation risk Cardiovascular System & Cardiology",
author = "Michelsen, {Trond M} and Adam Pena and Mygind, {Naja Dam} and D. Frestad and I. Gustafsson and Hansen, {H. S.} and J. Kastrup and J Bech and N. H{\o}st and E. Prescott",
note = "ISI Document Delivery No.: DQ4DV Times Cited: 1 Cited Reference Count: 28 Michelsen, Marie M. Pena, Adam Mygind, Naja D. Frestad, Daria Gustafsson, Ida Hansen, Henrik S. Kastrup, Jens Bech, Jan Host, Nis Prescott, Eva Danish Heart Foundation; University of Copenhagen The authors thank the Danish Heart Foundation and the University of Copenhagen for financial support, making this research possible. The authors also thank everyone in the iPOWER research group, as well as the Department of Cardiology at Bispebjerg Hospital, Copenhagen University Hospital (Copenhagen, Denmark), where the examinations took place. Last but not least, the authors thank all participating women in iPOWER for their time and willingness to contribute to the research. 1 Mosby-elsevier New york",
year = "2016",
doi = "10.1016/j.echo.2016.02.011",
language = "English",
volume = "29",
pages = "709--716",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Heinemann",
number = "7",

}

Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality. / Michelsen, Trond M; Pena, Adam; Mygind, Naja Dam; Frestad, D.; Gustafsson, I.; Hansen, H. S.; Kastrup, J.; Bech, J; Høst, N.; Prescott, E.

In: Journal of the American Society of Echocardiography, Vol. 29, No. 7, 2016, p. 709-716.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality

AU - Michelsen, Trond M

AU - Pena, Adam

AU - Mygind, Naja Dam

AU - Frestad, D.

AU - Gustafsson, I.

AU - Hansen, H. S.

AU - Kastrup, J.

AU - Bech, J

AU - Høst, N.

AU - Prescott, E.

N1 - ISI Document Delivery No.: DQ4DV Times Cited: 1 Cited Reference Count: 28 Michelsen, Marie M. Pena, Adam Mygind, Naja D. Frestad, Daria Gustafsson, Ida Hansen, Henrik S. Kastrup, Jens Bech, Jan Host, Nis Prescott, Eva Danish Heart Foundation; University of Copenhagen The authors thank the Danish Heart Foundation and the University of Copenhagen for financial support, making this research possible. The authors also thank everyone in the iPOWER research group, as well as the Department of Cardiology at Bispebjerg Hospital, Copenhagen University Hospital (Copenhagen, Denmark), where the examinations took place. Last but not least, the authors thank all participating women in iPOWER for their time and willingness to contribute to the research. 1 Mosby-elsevier New york

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Coronary flow velocity reserve Transthoracic Doppler echocardiography Coronary microvascular function Feasibility Quality intracoronary doppler prognostic value stress echocardiography microvascular disease artery-disease angiography tomography validation

U2 - 10.1016/j.echo.2016.02.011

DO - 10.1016/j.echo.2016.02.011

M3 - Journal article

VL - 29

SP - 709

EP - 716

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 7

ER -