Document Detail


Noninvasive assessment of left and right internal mammary artery graft patency using transthoracic color Doppler echocardiography.
MedLine Citation:
PMID:  12784743     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to evaluate the patency of left and right internal mammary artery grafts respectively on the left anterior descending and right coronary artery by noninvasive transthoracic color Doppler echocardiography. METHODS: Thirty eight patients (34 males, 4 females, mean age 59 +/- 2 years), with a history of coronary artery bypass grafting for a total of 42 mammary artery grafts, were studied by means of color Doppler echocardiography at baseline and after vasodilation with dipyridamole infusion (0.56 mg/kg i.v. over 4 min). The evaluated echocardiographic parameters included: systolic (SPV) and diastolic peak velocities (DPV), systolic (SVI) and diastolic velocity-time integrals (DVI), and the DPV/SPV and DVI/SVI ratios. We also calculated the dipyridamole infusion to baseline ratio of the diastolic peak velocities (DPVdip/DPVbaseline), the index of internal mammary artery graft blood flow reserve and the percent DPV increment as an index of graft stenosis. RESULTS: On the basis of coronary angiography, two groups were selected: group A (36 mammary grafts) with patent grafts and group B (6 mammary grafts) with moderate or severe stenosis of the grafts. Group A had a predominant diastolic pattern with a DPV of 0.24 +/- 0.13 m/s, whereas group B had a predominant systolic pattern with a reduced DPV of 0.12 +/- 0.03 m/s (p < 0.01). Dipyridamole induced an increase in the DPV respectively of 86.8 +/- 64.4% in group A and 13.8 +/- 15.9% in group B (p < 0.001). Statistical analysis (Mann-Whitney test) revealed a significant difference between the two groups for the baseline DPV (p < 0.01), DVI (p < 0.05), DPV/SPV ratio (p < 0.005), DVI/SVI ratio (p < 0.05), and for the after dipyridamole infusion values: DPV (p < 0.0001), DVI (p < 0.005), DPV/SPV ratio (p < 0.001), and DVI/SVI ratio (p < 0.05). Multivariate analysis showed that the percent DPV increment, the DPVdip/DPVbaseline ratio and the baseline DPV were independent determinants of the stenosis as evaluated at angiography (beta = -0.38, p < 0.01; beta = -0.37, p < 0.01, and beta = -0.33, p < 0.05, respectively; cumulative r2 = 0.25, standard error 0.30 m/s, p < 0.005). CONCLUSIONS: The echocardiographic evaluation of the mammary grafts is a simple, noninvasive method for the assessment of the graft patency and of the functional status of the vessel. The percent DPV increment and baseline DPV were independent determinants of mammary graft stenosis.
Authors:
Luigi De Simone; Pio Caso; Sergio Severino; Silvana Cicala; Maurizio Galderisi; Attilio Renzulli; Giulio Bonzani; Marino Scherillo; Nicola Mininni; Maurizio Cotrufo
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Italian heart journal : official journal of the Italian Federation of Cardiology     Volume:  4     ISSN:  1129-471X     ISO Abbreviation:  Ital Heart J     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-06-04     Completed Date:  2003-09-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100909716     Medline TA:  Ital Heart J     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  173-8     Citation Subset:  IM    
Affiliation:
Cardiology Department, Monaldi Hospital, Naples, Italy. ldesimone@cardionet.it
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MeSH Terms
Descriptor/Qualifier:
Blood Flow Velocity / drug effects,  physiology
Coronary Angiography
Coronary Artery Bypass*
Diastole / drug effects,  physiology
Dipyridamole / therapeutic use
Echocardiography*
Echocardiography, Doppler, Color
Female
Graft Occlusion, Vascular / diagnosis,  physiopathology
Humans
Infusions, Intra-Arterial
Male
Mammary Arteries / radiography,  surgery*,  ultrasonography*
Middle Aged
Multivariate Analysis
Observer Variation
Reproducibility of Results
Severity of Illness Index
Statistics as Topic
Systole / drug effects,  physiology
Treatment Outcome
Vascular Patency / drug effects,  physiology*
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 58-32-2/Dipyridamole

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