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By Paweł Petkow-Dimitrow MD (auth.)

Coronary move reserve is a vital practical parameter to appreciate the pathophysiology of coronary circulate. Coronary movement reserve size is used to evaluate epicardial coronary stenoses or to check the integrity of microvascular flow. An appreciation of coronary body structure is an essential component of medical decision-making for cardiologists treating sufferers with coronary artery affliction. The pioneering examine efforts of Dr Lance Gould, who explored the connection among the anatomic severity of a stenosis and its circulate resistance (59;60) , were transferred to medical perform (94; 194). within the absence of stenosis in epicardial coronary artery, the coronary movement reserve can be lowered while coronary microvascular stream is compromised through arterial high blood pressure without or with left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, or different illnesses. a number of options were tested for measuring coronary movement reserve. even though, those ideas are both invasive (intracoronary Doppler circulation wire), hugely dear and scarcely to be had (Positron Emission Tomography - puppy) or semi-invasive and inflicting sufferer ache (transesophageal Doppler echocardiography), therefore their scientific use is proscribed. a result of medical value of coronary circulation reserve there's a want for an easy, noninvasive, repeatable and cheap software able to this practical overview. This monograph makes a speciality of the overview of coronary circulate reserve utilizing transthoracic Doppler echocardiography - the strategy gratifying the above-mentioned standards. Transthoracic Doppler echocardiography has develop into a favored software evolving from a learn to diagnostic process utilized in daily practice.

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Extra info for Coronary flow reserve - measurement and application: Focus on transthoracic Doppler echocardiography

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Postprocedural relative coronary flow reserve <0,78 has been independently found predictive of the elevation of enzymatic marker of myocardial injury despite angiographically successful PTCA (67). It should be remembered that the measurement of relative coronary flow reserve is precise only on condition that the severity of microcirculatory impairment is comparable in the vascular bed of target and reference vessel. This condition cannot be always met because of regional variation (heterogeneity) in coronary flow reserve between various segments of myocardial wall (74).

5. 6. are an illustration of echocardiographic measurements of trans-stenotic pressure gradient and FFR. Figure 3-5. Trans-stenotic pressure gradient measured by transthoracic Doppler echocardiography in patients with significant stenosis in proximal segment of LAD at coronary angiogram. Spectral Doppler tracings of coronary flow velocity was recorded at site of stenosis: [Aj pre-PTCA baseline (max. gradient 20,4 mmHg and calculated mean gradient 7,3 mmHg): [Hj pre-PTCA peak adenosine (max. gradient 61,3 mmHg and calculated mean gradient 37,4 mmHg): [C] post-PTCA baseline (max.

Table 4-1. summarizes the advantages and disadvantages of Doppler technique. 1 Advantages of the method: Noninvasive measurements The measurement of coronary blood flow velocity using transthoracic Doppler echocardiography is noninvasive. Therefore, the measurement is 4. Noninvasive assessment of coronary flow reserve 45 unstressed and absolutely safe for the patients. This comfortable examination provides a possibility of repeating the study for a number of times, which in tum allows for evaluation of various stressors and effects of different pharmacological treatment influencing coronary blood flow in a given patient (137-141).

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