881-1 Triggered replenishment imaging improves reproducibility of myocardial contrast echocardiography

Background: Recent advances in transthoracic color Doppler echocardiography provide coronary flow velocity measurement in the left anterior descending coronary artery (LAD). There were few reports that the diastolic to systolic peak velocity ratio (DSVR) measurement by transthoracic color Doppler echocardiography was a simple and noninvasive method for detection of severe stenosis at rest. The purpose of this study is to evaluate the value of DSVR for the noninvasive detection of severe stenosis and total occlusion of LAD in the patients with acute coronary syndrome in emergency room. Methods: Using transthoracic pulsed color Doppler echocardiography, we recorded coronary flow velocity of LAD in 23 consecutive patients (pts) with acute coronary syndrome in emergency room. We measured diastolic peak velocity (DVp) and systolic peak velocity (SVp) and calculated DSVR (=DVp/SVp). To confirm LAD flow, emergent coronary angiography was performed immediately. Results: We detected LAD in 20 out of 23 pts. 2 of 3 pts who had not been detected of LAD revealed total occlusions by coronary angiography. 12 pts had severe stenosis (>90%) of LAD. DSVR of LAD is significantly lower in pts of group with severe stenosis than pts of group without severe stenosis (1.34±0.31 vs. 2.11±0.31, p<0.0001). Conclusions: Noninvasive detection of LAD flow and DSVR can accurately diagnose severe stenosis and total occlusion of LAD in emergency room.