Circulation, Vol 81, 1319-1330, Copyright © 1990 by American Heart Association
AL McGinn, CW White and RF Wilson
To define the long-term variability of serial coronary flow reserve (CFR)
measurements in humans and to evaluate the influence of changes in heart
rate, mean arterial pressure, and left ventricular preload on CFR, 45
patients with normal left ventricular function (38 cardiac allograft
recipients, five patients with normal coronary arteries, and two patients
with minimal coronary artery disease [less than 50% diameter stenosis])
were studied. CFR (ratio of peak hyperemic [h] to resting [r] coronary
blood flow velocity [CBFV]) was measured with a 3F coronary Doppler
catheter and intracoronary papaverine. Initial CFR measurements were highly
correlated with repeat measurements obtained 11 +/- 0.6 months later (r =
0.95; mean absolute difference, 0.3 +/- 0.1; n = 17). Differences in CFR
between studies were related to changes in heart rate (r = 0.61, p = 0.01)
but not to changes in mean arterial pressure (r = 0.25, p = 0.33). To
define the effects of rapid changes in heart rate, mean arterial pressure,
and preload on CFR, these variables were altered by atrial pacing, handgrip
exercise, and volume expansion, respectively. Atrial pacing produced a
rate-related increase in rCBFV but did not change hCBFV. Consequently, CFR
was significantly reduced as heart rate was increased progressively from 76
+/- 2 in sinus rhythm (4.5 +/- 0.2) to 100 (3.8 +/- 0.2, p less than 0.05,
n = 32) to 120 beats/min (3.2 +/- 0.1, p less than 0.05, n = 7). Despite a
19 +/- 2 mm Hg rise in mean arterial pressure during handgrip exercise, CFR
was unchanged from baseline (3.7 +/- 0.3 vs. 3.7 +/- 0.4, p = NS, n = 7)
because rCBFV rose proportionally with hCBFV. When pulmonary capillary
wedge pressure was increased from 9 +/- 1 to 16 +/- 1 mm Hg after volume
expansion, CFR was significantly decreased (from 3.8 +/- 0.2 to 2.9 +/-
0.2, p less than 0.05, n = 9) because rCBFV was increased while hCBFV
remained unchanged. Hence, serial CFR measurements in humans are highly
reproducible in the absence of conditions known to affect resting or
hyperemic coronary blood flow. Increases in heart rate or preload reduced
CFR because rCBFV was increased while hCBFV was unchanged. In contrast,
changes in mean arterial pressure did not alter CFR. Proper interpretation
of CFR measurements should take into account the hemodynamic conditions at
which they are obtained.
ARTICLES
Interstudy variability of coronary flow reserve. Influence of heart rate, arterial pressure, and ventricular preload
Department of Medicine, University of Minnesota, Minneapolis 55455.
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