Circulation, Vol 88, 62-69, Copyright © 1993 by American Heart Association
J Czernin, P Muller, S Chan, RC Brunken, G Porenta, J Krivokapich, K Chen, A Chan, ME Phelps and HR Schelbert
BACKGROUND. Aging is associated with changes of the systolic blood pressure
that may increase cardiac work and myocardial blood flow at rest and reduce
the myocardial flow reserve. This might be misinterpreted as age-related
impairment of the coronary vasodilator capacity. METHODS AND RESULTS.
Myocardial blood flow was quantified at rest and after administration of
intravenous dipyridamole in 40 healthy volunteers (12 women and 28 men)
with 13N-ammonia and positron emission tomography. Eighteen of the normal
subjects were less than and 22 were older than 50 years (31 +/- 9 versus 64
+/- 9 years). The resting rate- pressure product was lower in the younger
than in the older subjects (6895 +/- 1070 versus 8634 +/- 1890; P <
0.01). Myocardial blood flow at rest averaged 0.76 +/- 0.17 mL.min-1.g-1 in
the younger volunteers and 0.92 +/- 0.25 mL.min-1.g-1 in the older
volunteers (P < 0.05). Hyperemic blood flows did not differ between
younger and older subjects (3.0 +/- 0.8 versus 2.7 +/- 0.6 mL.min-1.g-1; P
= NS); however, minimal coronary resistance was higher in the older
subjects. Corrected for indexes of coronary driving pressure, hyperemic
flow was lower in older than in younger normal subjects. The higher resting
blood flows combined with similar hyperemic flows resulted in a lower
myocardial flow reserve in the older than in the younger normal subjects
(4.1 +/- 0.9 versus 3.0 +/- 0.70; P < 0.0001). The flow reserve was more
closely correlated with resting than with hyperemic blood flows.
CONCLUSIONS. Aging does not alter significantly dipyridamole-induced
hyperemic flows; although coronary vascular resistance after dipyridamole
was somewhat increased in older subjects. The gradual decline of the
myocardial blood flow reserve correlates with an age-related increase of
baseline myocardial work and blood flow. These findings suggest that the
reduced flow reserve with age is primarily due to increased cardiac work
and blood flow at rest rather than to an abnormal vasodilator capacity.
ARTICLES
Influence of age and hemodynamics on myocardial blood flow and flow reserve
Department of Radiological Sciences, UCLA School of Medicine 90024-1721.
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