Transthoracic echocardiography in the detection of chronic total coronary artery occlusion

The aim of our study was to detect chronic total occlusion of the left anterior descending coronary artery (LAD), circumflex coronary artery (Cx), and right coronary artery (RCA) using transthoracic echocardiography (TTE) in 110 consecutive patients who underwent coronary angiography for investigation of angina. Coronary blood flow direction was assessed in the epicardial collaterals [distal LAD (dLAD), obtuse marginal branches and right posterior descending artery (PDA)] and intramyocardial collaterals [LAD septal branch (SB LAD) and RCA septal branch (SB RCA)]. The sensitivity and specificity of retrograde flow for identification of the occluded LAD by TTE in the dLAD only were 78 and 96%, respectively, and those in both dLAD and SB LAD were 89 and 96%, respectively. The retrograde SB LAD flow detects proximal LAD occlusion with 88% sensitivity and 75% specificity. The sensitivity and specificity of retrograde flow for identification of the occluded RCA by TTE in the PDA only were 79 and 97%, respectively, and those in both PDA and SB RCA were 89 and 97%, respectively. The retrograde SB RCA flow does not allow us to differentiate between proximal and non-proximal RCA occlusion. Transthoracic echocardiography is not a method for diagnosing Cx occlusions as the success in visualizing the Cx epicardial collaterals was achieved in 31% of cases only. TTE is a sensitive and highly specific non-invasive method for diagnosis of LAD and RCA occlusions, based on the detection of the coronary blood flow direction in the epicardial and intramyocardial collaterals.