Transthoracic, harmonic mode, contrast enhanced color Doppler echocardiography in detection of restenosis after percutaneous coronary interventions. Prospective evaluation verified by coronary angiography

Abstract

AIMS: To test the feasibility and accuracy of transthoracic, harmonic mode, contrast enhanced Doppler echocardiographic assessment of lesion severity after PCI treatment in native coronary arteries--the LAD, Cx and RCA. METHODS AND RESULTS: Prospective evaluation of 59 patients (66 arteries). Restenosis was diagnosed whenever maximal flow velocity at least doubled in comparison to the segment immediately proximal to the PCI site or when local velocity was at least 2 m/s. At 9 months of follow-up final comparison of Doppler echocardiography and coronary angiography was performed with regard to 44 arteries in 40 patients. Of LAD segments assessed, 15 were proximal and 15 middle. The figures for Cx segments were: 4 proximal and 2 mid, and for RCA 2 proximal, 5 middle and 1 distal (i.e. the posterior descending coronary artery). On final coronary angiography there were 8 restenoses--all correctly diagnosed by echocardiography. There were 2 false-positive diagnoses of restenosis. Specificity for restenosis detection was 94% and sensitivity 100%. CONCLUSION: Transthoracic echocardiography allowed for accurate stenosis assessment of principal coronary arteries after successful PTCA. Feasibility of lesion site visualization was 100% for the LAD, 75% for the Cx and 43% for the RCA. Ultrasound contrast agent improved the quality of the RCA images.