Vol. 27 No. 3 (2023)
CORONARY ARTERY DISEASES

Diagnostic value of coronary flow acceleration measured by transesophageal echocardiography in coronary artery bypass graft surgery

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  • S.M. Efremov,
  • M.A. Novikov,
  • A.A. Trofimov,
  • D.V. Shmatov,
  • M.S. Kamenskih,
  • A.V. Zagatina
S.M. Efremov
Saint Petersburg State University N.I. Pirogov Centre of High Medical Technologies, Saint Petersburg
M.A. Novikov
Saint Petersburg State University N.I. Pirogov Centre of High Medical Technologies, Saint Petersburg
A.A. Trofimov
Saint Petersburg State University, Saint Petersburg
Bio
D.V. Shmatov
Saint Petersburg State University N.I. Pirogov Centre of High Medical Technologies, Saint Petersburg
M.S. Kamenskih
Saint Petersburg State University N.I. Pirogov Centre of High Medical Technologies, Saint Petersburg
A.V. Zagatina
Multidisciplinary Clinic “Medica”, Saint Petersburg
Visualization of stenosis in the zone of blood flow acceleration in the anterior interventricular artery
DOI: https://doi.org/10.21688/1681-3472-2023-3-44-52

Published 2023-09-29

Keywords

  • Coronary Artery Bypass,
  • Coronary Artery Disease,
  • Coronary Circulation,
  • Coronary Vessels,
  • Echocardiography, Transesophageal,
  • Myocardial Infarction,
  • Prospective Studies
    • ...More
    Less

How to Cite

Efremov, S., Novikov, M., Trofimov, A., Shmatov, D., Kamenskih, M., & Zagatina, A. (2023). Diagnostic value of coronary flow acceleration measured by transesophageal echocardiography in coronary artery bypass graft surgery. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 27(3), 44–52. https://doi.org/10.21688/1681-3472-2023-3-44-52

Copyright (c) 2023 Efremov S.M., Novikov M.A., Trofimov A.A., Shmatov D.V., Kamenskih M.S., Zagatina A.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background: Transesophageal echocardiography as a method of intraoperative coronary flow assessment is largely unstudied.
Objective: To evaluate the potential of intraoperative transesophageal echocardiography in diagnosing proximal coronary artery stenoses, to reveal the correlation between stenoses found on coronary angiography and coronary flow velocity in the corresponding area measured by intraoperative transesophageal echocardiography, and to study how coronary flow velocity changes before and after coronary artery bypass graft surgery and how it is related to postoperative myocardial injury.
Methods: Our prospective cohort study included 186 patients scheduled for coronary artery bypass graft surgery. All the patients underwent intraoperative transesophageal echocardiography: coronary flow velocity was measured in the area of its acceleration (proximal parts of the left coronary artery) before and after the surgery. Troponin I was measured on the first postoperative day.
Results: The areas of accelerated coronary flow before the procedure were detected in the left main coronary artery (88 patients, 47.3%), left anterior descending artery (146 patients, 78.5%), and left circumflex artery (28 patients, 15.1%). ROC analysis showed that coronary flow velocity of >73 cm/s in the left main coronary artery and of >91 cm/s in the left circumflex artery was associated with a stenosis of 50% and 70% in the respective arteries measured by coronary angiography. Furthermore, an increase in coronary flow velocity in the left anterior descending artery or its decrease by 4 cm/s after coronary artery bypass graft surgery are predictors of a 10-fold increase in troponin I concentration in the postoperative period.
Conclusion: Coronary flow velocity assessment during intraoperative transesophageal echocardiography can offer added value in detecting clinically significant coronary artery stenoses, while assessment of changes in velocity may predict perioperative myocardial injury.

Received 16 January 2023. Revised 16 May 2023. Accepted 31 August 2023.

Funding: The study did not have sponsorship.

Conflict of interest: The authors declare no conflict of interest.

Contribution of the authors
Conception and study design: S.M. Efremov, M.A. Novikov, A.V. Zagatina
Data collection and analysis: S.M. Efremov, M.A. Novikov, A.A. Trofimov, A.V. Zagatina
Statistical analysis: S.M. Efremov, A.A. Trofimov
Drafting the article: S.M. Efremov, A.A. Trofimov
Critical revision of the article: S.M. Efremov, M.A. Novikov, A.A. Trofimov, D.V. Shmatov, M.S. Kamenskih, A.V. Zagatina
Final approval of the version to be published: S.M. Efremov, M.A. Novikov, A.A. Trofimov, D.V. Shmatov, M.S. Kamenskih, A.V. Zagatina

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