Coronary flow reserve - measurement and application: Focus on transthoracic Doppler echocardiography: Focus on Transthoracic Doppler Echocardiography
Coronary flow reserve is an important functional parameter to understand the pathophysiology of coronary circulation. Coronary flow reserve measurement is used to assess epicardial coronary stenoses or to examine the integrity of microvascular circulation. An appreciation of coronary physiology is an integral part of clinical decision-making for cardiologists treating patients with coronary artery disease. The pioneering research efforts of Dr Lance Gould, who explored the relationship between the anatomic severity of a stenosis and its flow resistance (59;60) , have been transferred to clinical practice (94; 194). In the absence of stenosis in epicardial coronary artery, the coronary flow reserve may be decreased when coronary microvascular circulation is compromised by arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, or other diseases. Several techniques have been established for measuring coronary flow reserve. However, these techniques are either invasive (intracoronary Doppler flow wire), highly expensive and scarcely available (Positron Emission Tomography - PET) or semi-invasive and causing patient discomfort (transesophageal Doppler echocardiography), thus their clinical use is limited. Because of the clinical importance of coronary flow reserve there is a need for a simple, noninvasive, repeatable and inexpensive tool capable of this functional evaluation. This monograph focuses on the assessment of coronary flow reserve using transthoracic Doppler echocardiography - the technique fulfilling the above-mentioned criteria. Transthoracic Doppler echocardiography has become a popular tool evolving from a research to diagnostic technique applied in everyday practice.
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BLOOD FLOW REGULATION IN CORONARY CIRCULATION
THE RANGE OF NORMAL VALUES FOR CORONARY FLOW RESERVE AND LESION SPECIFIC PHYSIOLOGICAL MEASUREMENTS
APPLICATION OF NONINVASIVE DOPPLER ECHOCARDIOGRAPHY MEASUREMENT OF CORONARY FLOW RESERVE
NONINVASIVE METHODS FOR EVALUATION OF CORONARY FLOW RESERVE METHODOLOGICAL CONSIDERATIONS
STIMULI TESTING CORONARY FLOW RESERVE
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abstract acetylcholine adenosine Am.J.Cardiol angioplasty arterial hypertension assessment of coronary atherosclerosis autoregulation baseline blood flow velocity cardiac Cardiol changes in coronary clinical cold pressor test coronary angiography coronary artery disease coronary blood flow coronary circulation coronary flow reserve coronary flow velocity coronary perfusion pressure coronary stenosis coronary vascular resistance decreased diastolic dipyridamole dobutamine double product EIDV endothelial dysfunction endothelium epicardial artery evaluation flow reserve measured flow velocity reserve fractional flow reserve handgrip hypercholesterolemia hypertrophic cardiomyopathy imaging impaired increase in coronary induced infusion invasive studies J.Am.Coll left ventricular maximal vasodilatation measurement of coronary metabolic stress test microcirculation microvascular myocardial ischemia myocardial oxygen demand myocardial perfusion noninvasive patients with hypertrophic pharmacological physiological proximal PTCA reduced coronary flow relative coronary flow restenosis risk factors smooth muscle spectral Doppler stenting stimulation systolic technique trans-stenotic pressure gradient transesophageal echocardiography transthoracic Doppler echocardiography transthoracic echocardiography value of coronary vasoconstriction vasodilatation vasodilator verapamil