Noninvasive detection of total occlusion of the left anterior descending coronary artery with transthoracic Doppler echocardiography

Objectives The purpose of this study was to evaluate the value of transthor acic Doppler echocardiography (TTDE) for the noninvasive detection of total left anterior descending coronary artery (LAD) occlusion. Background Total coronary occlusion is associated with an adverse long-term prognosis, and mechanical revascularization may be required for the patien t with total coronary occlusion. However, a noninvasive diagnosis of total coronary occlusion before coronary angiography (CAG) has been difficult, es pecially in patients without clinical signs. Methods We studied 103 consecutive patients who underwent CAG for the evalu ation of coronary artery disease. The study group consisted of 16 patients with total LAD occlusion (group A) and 87 patients without total LAD occlus ion (group B). Coronary flow velocity in the mid-portion of the LAD was rec orded by TTDE. Results Adequate spectral Doppler recordings of diastolic flow in the LAD w ere obtained in 98 study patients (95%; 15 patients in group A and 83 patie nts in group B). In group A, retrograde LAD flow was obtained in 14 (93%) o f 15 patients. The mean diastolic velocity of the retrograde flow was 21.0 +/-6.1 cm/s. In group B, antegrade LAD flow was obtained in all 83 patients (100%). The mean diastolic velocity of the antegrade flow was 21.5 +/-7.1 cm/s. Retrograde LAD flow by TTDE had a sensitivity of 93% and a specificit y of 100% for the detection of total LAD occlusion. Conclusions Retrograde flow in the LAD by TTDE is a highly sensitive and sp ecific finding that can be used to noninvasively diagnose total LAD occlusi on. (J Am Coll Cardiol 2001;38:1328-32) (C) 2001 by the American College of Cardiology.