Two cases of unstable angina with proximal coronary artery stenosis diagnosed by transthoracic Doppler echocardiography

Abstract

We used transthoracic Doppler echocardiography (TTDE) to describe the coronary artery and evaluate coronary circulation by analyzing coronary flow pattern. While many studies report on use of transthoracic Doppler echocardiography in evaluating the distal coronary artery, few evaluate the proximal coronary artery. We describe use of transthoracic Doppler echocardiography in two cases of unstable angina diagnosed in the stenotic region in the proximal coronary artery. Case 1: This case occurred in a 79-year-old man admitted after complaining of chest pain. The electrocardiogram obtained at time of admission showed ST depression in leads II , III, aVF, and V_3-6. The echocardiogram demonstrated hypokinesis at the apex of left ventricular (LV) wall. Coronary Doppler echocardiography showed acceleration flow at the proximal left anterior descending artery (LAD), and diastolic peak velocity at this portion was 104 cm/s. Coronary angiography showed 99% stenosis at LAD#6, the portion of the stenotic region studied using transthoracic Doppler echocardiography. Stent implantation was carried out, and dilatation was successful. No acceleration flow was seen after stenting, and peak diastolic velocity was reduced at 40 cm/s. Case 2: This case occurred in a 59-year-old man who was also hospitalized after complaining of chest pain. The electrocardiogram acquired at time of admission showed negative T wave in leads II , III, and aVF. There was no wall motion abnormality, but acceleration flow was observed in the proximal right coronary artery (RCA), and peak diastolic velocity in this portion was 108 cm/s. Coronary angiography showed 99% stenosis at RCA#1, the portion of the stenotic region studied with transthoracic Doppler echocardiography. Stent implantation was carried out and dilatation was successful. No acceleration flow was seen, and peak diastolic velocity was normalized at 26 cm/s. Transthoracic Doppler echocardiography revealed proximal coronary stenosis directly. Transthoracic Doppler echocardiography was useful in predicting proximal coronary stenosis non-invasively before obtaining a coronary angiogram in patients with unstable angina without ST elevation.