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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

From: Transthoracic Doppler echocardiography – noninvasive diagnostic window for coronary flow reserve assessment

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  
  1. WM – wall motion, LV – left ventricular