Usefulness of three-dimensional transesophageal echocardiographic imaging for evaluating narrowing in the coronary arteries

Coronary artery (CA) imaging has relied on invasive techniques for diagnosing stenotic lesions. Two-dimensional techniques are limited in obtaining optimal longitudinal views of all segments of the CA because of their spatial orientations. Three-dimensional echocardiography (3DE) may produce any desired cross-sectional views and reconstruct 3-dimensional images from a volumetric data set. Its role in CA imaging has not been fully explored. The aim of this study was to evaluate the potential of 3DE in visualizing CAs and in assessing the severity of stenosis. We performed transesophageal 3DE in 46 patients. Images were collected sequentially with the transducer rotated through 180°. From the 3DE data sets of all 46 patients, crass-sectional views and 3-dimensional images of CAs were reconstructed. For segment-by-segment comparison between CA angiography and 3DE in semiquantitative analysis of coronary stenosis, 5 segments were defined for the praximal CA tree in 20 patients who underwent both procedures. The left main, anterior descending, circumflex, and right CAs were visualized from 3DE in 100%, 100%, 98%, and 72%. The available lengths of these segments from 3DE were 12 ± 4 mm (range 4 to 22), 15 ± 6 mm (range 6 to 36), 30 ± 12 mm (range 13 to 60), and 18 ± 9 mm (range 6 to 36), respectively. Comparison between 3DE and CA angiography in semiquantitative estimation of CA stenosis resulted in complete agreement in 83% of the segments (κ value = 0.7). The sensitivity and specificity of 3DE in detecting significant stenosis (≥50%) were 84% and 97%. In conclusion, transesophageal 3DE allows imaging of the proximal CA, detection of stenotic lesions, and estimation of the severity of stenosis.

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