Usefulness of three-dimensional transesophageal echocardiographic imaging for evaluating narrowing in the coronary arteries

Coronary artery (CA) imaging has relied on invasive techniques for diagnosi ng stenotic lesions. Two-dimensional techniques are limited in obtaining op timal longitudinal views of all segments of the CA because of their spatial orientations. Three-dimensional echocardiography (3DE) may produce any des ired cross-sectional views and reconstruct 3-dimensional images from a volu metric data set. Its role in CA imaging has not been fully explored. The ai m of this study was to evaluate the potential of 3DE in visualizing CAs and in assessing the severity of stenosis, We performed transesophageal 3DE in 46 patients. Images were collected sequentially with the transducer rotate d through 180 degrees. From the 3DE data sets of all 46 patients, cross-sec tional views and 3-dimensional images of CAs were reconstructed. For segmen t-by-segment comparison between CA angiography and 3DE in semiquantitative analysis of coronary stenosis, 5 segments were defined for the proximal CA tree in 20 patients who underwent both procedures. The left main, anterior descending, circumflex, and right CAs were visualized from 3DE in 100%, 100 %, 98%, and 72%. The available lengths of these segments from 3DE were 12 /- 4 mm (range 4 to 22), 15 +/- 6 mm (range 6 to 36), 30 +/- 12 mm (range 1 3 to 60], and 18 +/- 9 mm (range 6 to 36), respectively. Comparison between 3DE and CA angiography in semiquantitative estimation of CA,stenosis resul ted in complete agreement in 83% of the segments (kappa value = 0.7). The s ensitivity and specificity of 3DE in detecting significant stenosis (greate r than or equal to 50%) were 84% and 97%. In conclusion, transesophageal 3D E allows imaging of the proximal CA, detection of stenotic lesions and esti mation of the severity of stenosis, (C) 1999 by Excerpta Medico, Inc.