Circulation, Vol 85, 1987-2003, Copyright © 1992 by American Heart Association
C Seiler, RL Kirkeeide and KL Gould
BACKGROUND. Quantitative coronary arteriography has been validated for
stenotic segments of coronary arteries. However, it does not currently
account for diffuse coronary artery disease, because the normal size of the
coronary artery for its distal myocardial bed size is not known and cannot
be measured directly with diffuse involvement of the artery. METHODS AND
RESULTS. From clinical coronary arteriograms of 12 patients without
coronary artery disease (group 1) and in 17 patients with coronary artery
disease (group 2), we determined by quantitative coronary arteriography 1)
the relations among measured coronary artery cross-sectional lumen area,
summed distal branch lengths, and regional myocardial mass distal to each
point in each coronary artery; 2) the ratio of coronary artery lumen area
between parent and daughter vessels at 50 bifurcations; and 3) which of
three different theoretical physical principles could underlie the tree
structure of the human coronary artery system, by comparing the coronary
artery size, branch lengths, regional mass, and relations between
parent-to-daughter lumen area ratios with those for the different
theoretical physical principles to test which principle best fit the
observed data and therefore which principle most probably characterizes the
human coronary artery tree structure. The results showed that 1) there is a
close correlation between the lumen area of a coronary artery at each point
along its length and the corresponding summed distal branch lengths and
regional myocardial mass in patients without and with coronary artery
disease; 2) measured coronary artery lumen area in patients with coronary
artery disease is diffusely 30-50% too small for distal myocardial bed size
compared with normal subjects; and 3) the observed relations among coronary
artery size, distal summed lengths, myocardial bed size, and
parent-to-daughter size ratios are not consistent with the theoretical
principle of constant mean blood flow velocity in the coronary circulation
but are consistent with the principles of minimum viscous energy loss and
of limited/adaptive vascular wall shear stress characterized by a 2/3 power
law relating coronary artery lumen area to distal summed branch lengths and
regional mass or parent-to-daughter branching ratios. CONCLUSIONS. These
observations provide a basis for quantifying diffuse coronary artery
disease on clinical arteriograms.
ARTICLES
Basic structure-function relations of the epicardial coronary vascular tree. Basis of quantitative coronary arteriography for diffuse coronary artery disease
University of Texas Medical School, Houston 77030.
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