Table 3 Proposed scheme of application of transthoracic Doppler echocardiography (with or without wall motion assessment) in diagnosis of epicardial or microvascular coronary vessel disease
| Before coronary angiography (nondiagnostic or equivocal exercise stress ECG) | |
|---|---|
| • Suspected epicardial coronary stenosis (LAD, Cx, RCA) |
• Suspected microvascular abnormalities (young patients with chest pain despite no risk factor for epicardial CAD) |
| 1. WM (LV global) assessment (if negative) | CFR in LAD |
| 2. CFR (regional assessment of LAD) | |
| After coronary angiography | |
| Abnormal coronary angiogram | Normal coronary angiogram |
| • Functional assessment of intermediate stenosis |
• Confirmation or exclusion of microvascular dysfunction in patients with chest pain |
| 1. Flow acceleration at stenotic site (if not possible) | CFR |
| 2. Dual assessment of WM + CFR | |
| Control during follow-up after initial coronary angiogram | |
| • Patients deferred from PTCA due to intermediate stenosis | • Verify the benefit of pharmacological interventions |
| • Patients with suspected restenosis | |
| 1. Flow acceleration at stenotic site (if not possible) | CFR |
| 2. Dual assessment of WM + CFR | |