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Objective: Noninvasive methods that have the ability to accurately detect restenosis have been desired in the selection of patients requiring further angiographic evaluation. The present study sought to evaluate the diagnostic potential of transthoracic Doppler echocardiography (TTDE), a noninvasive method for evaluating coronary flow velocity reserve (CFVR), in detecting restenosis after percutaneous coronary intervention (PCI). Methods: We studied 107 consecutive patients 6 months after undergoing successful PCI on the left anterior descending coronary artery (LAD) lesions for relief of angina pectoris. The flow velocity in the distal LAD was measured by TTDE both at rest and during intravenous infusion of adenosine triphosphate. CFVR was calculated as the ratio of hyperemic to basal mean diastolic flow velocities. We defined a reversible perfusion defect in exercise Tl-201 single-photon emission computed tomography (SPECT) as restenosis. The CFVR measurements by TTDE were compared with the results of SPECT. Results: Complete TTDE data were acquired for 105 of the 107 study patients. A contrast agent was used to obtain adequate Doppler signals in 29 patients. Of the 105 patients, there were 18 patients with abnormal perfusion (group A) and 87 patients with normal perfusion (group B) in the LAD territories on Tl-201 SPECT. CFVR was greater in group B than in group A (1.7 +/- 0.5 vs. 3.7 +/- 0.8, P < 0.0001, respectively). There were 17 patients with CFVR < 2 and 88 patients with CFVR >= 2. CFVR < 2 predicted restenosis determined by Tl-201 SPECT, with a sensitivity of 94% and a specificity of 100%. Conclusions: Noninvasive measurement of CFVR by TTDE accurately reflects the physiological severity of coronary narrowing due to restenosis after PCI. This method has possibility of reducing the number of unnecessary coronary angiographies after PCI.

Background: We hypothesized that detection of reverse flow in the distal right coronary artery (d-RCA) and the inferior septal branches (ISB) by transthoracic Doppler echocardiography (TTDE) would be useful for noninvasive diagnosis of the occluded right coronary artery (RCA). Methods: Coronary angiography and TTDE were performed on 129 patients. Antegrade flows in the d-RCA and the ISB were defined as directions from the base to the apex in the posterior sulcus and from anterior to inferior in the inferior septum, respectively. Retrograde flow was defined as an inverse direction. Results: Retrograde flow was obtained by TTDE in 14 patients (d-RCA:11, ISB:3) of 18 patients with occluded RCA. The sensitivity and the specificity for identification of occluded RCA were 100% and 97.8%, respectively. Conclusion: Detection of reverse flow in the d-RCA and the ISB using TTDE is a useful method for the noninvasive diagnosis of occluded RCA.