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Background The intracoronary Doppler tipped guide wire has been shown to be highly accurate in the measurement of coronary flow velocity (CFV). Recent studies have indicated that blood flow velocity in the left anterior descending coronary artery (LAD) can be determined by transesophageal echocardiography (TEE). The purpose of this study was to compare flow velocity recordings and coronary flow reserve measurements in the LAD by TEE with those obtained by Doppler guide wire. Methods and Results The study population consisted of 14 patients with chest pain and normal coronary arteriograms. After routine coronary arteriography was performed, a 0.014-inch Doppler guide wire was advanced into the proximal part of the LAD. After baseline measurement of coronary flow velocity (CFV) was obtained, 140 @mg/kg/min adenosine was administered intravenously for 3 minutes, and the flow velocity was recorded. TEE was performed within 24 hours of the cardiac catheterization. After baseline measurements of CFV in the LAD, heart rate, and blood pressure were obtained, 140 @mg/kg/min adenosine was administered intravenously, and the CFV was recorded. Coronary flow reserve was calculated as the ratio of the peak diastolic CFV during adenosine infusion to the peak diastolic CFV at baseline. A good correlation was found (r = 0.91, p < 0.0001) between CFV by Doppler guide wire and that determined by TEE. A good correlation was also found between the coronary flow reserve assessed by Doppler guide wire and that determined by TEE (r = 0.92, p < 0.0001). Conclusion Our data indicate that CFV and coronary flow reserve in the LAD can be accurately measured by transesophageal echocardiography. (Am Heart J 1998;135:38-42.)

Doppler velocimetry with the use of transesophageal echocardiography can record flow in the proximal left anterior descending artery (LAD). To assess whether this limited sampling ability influences the recording of velocity and the calculation of coronary flow reserve (CFR), 32 patients with LAD stenosis (4 ostial stenoses, 18 proximal stenoses, 10 mid-LAD stenoses) and 33 patients with arteriographically normal LADs were studied. Basal flow and dipyridamole-induced hyperemic flow rates were recorded. The mean basal flow velocity in ostial stenoses was greater than in other groups, and the mean basal flow velocity in proximal stenoses was less than that in mid-LAD stenoses and in the normal group. Maximal hyperemic velocity did not differ between the groups. CFR in all stenoses groups was less than that in the normal group. Ostial CFR was less than in all other groups, and proximal CFR was less than that in either the mid-LAD or the normal LAD groups. With this technique, coronary flow velocimetry and estimation of CFR is affected by the location of stenosis. (Am Heart J 1997;133:44-52.)