Circulation, Vol 65, 928-935, Copyright © 1982 by American Heart Association
RJ Bache and JS Schwartz
We tested the hypothesis that reductions of perfusion pressure distal to a
flow-limiting coronary artery stenosis can directly impair perfusion of the
subendocardial myocardium. Dogs were instrumented with an electromagnetic
flowmeter probe and a variable occluder on the proximal left circumflex
coronary artery. Coronary perfusion pressure was measured with a catheter
distal to the occluder. Coronary autoregulation was abolished by
intraarterial infusion of adenosine to produce maximal coronary
vasodilation. The transmural distribution of myocardial blood flow was
measured with radioactive microspheres during unimpeded arterial inflow,
when the occluder was progressively narrowed to reduce distal coronary
pressure to approximately 70%, 50% and 35% of the control coronary
perfusion pressure, and during total coronary occlusion. Heart rate, left
ventricular diastolic pressure and the fraction of coronary artery flow
during systole remained constant throughout the study. Progressive
reductions of coronary perfusion pressure were accompanied by direct
reductions of the subendocardial/subepicardial blood flow ratio (r = 0.83).
Examination of the relationship between myocardial blood flow and coronary
perfusion pressure showed that blood flow decreased linearly with perfusion
pressure, with flow ceasing at a positive pressure (zero-flow pressure).
Blood flow data from four transmural myocardial layers from epicardium to
endocardium showed that this zero-flow pressure increased progressively
from 10 +/- 2.1 mm Hg in the subepicardium to 18 +/- 2.3 mm Hg in the
subendocardium (p less than -.01). Consequently, as coronary pressure was
reduced, the zero-flow pressure represented a progressively greater
fraction of coronary pressure in the subendocardium than in the
subepicardium. This effect appeared to account for the progressive
redistribution of blood flow away from the subendocardium that occurred as
coronary pressure was decreased. Myocardial vascular resistance did not
change as a result of changes in coronary perfusion pressure.
ARTICLES
Effect of perfusion pressure distal to a coronary stenosis on transmural myocardial blood flow
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