From the National Heart and Lung Institute, Imperial College School of
Medicine, Hammersmith Hospital, London, UK.
Correspondence to J.S. Kooner, MD, FRCP, Consulting Cardiologist, National Heart and Lung Institute, Imperial College of Medicine, Hammersmith Hospital, Du Cane Road, London W12ONN UK.
Background—Postprandial angina
pectoris has been recognized for more than two centuries and can be
identified in up to 10% of patients with chronic ischemic
heart disease. Redistribution of myocardial blood flow, from a region
supplied by a severely stenotic coronary artery to
those supplied by less diseased or normal vessels, is a potential
mechanism of postprandial angina.
Methods and Results—To test this hypothesis, we have determined
the effects of a standard liquid meal on whole heart and regional
myocardial blood flow, measured by means of dynamic positron emission
tomography (PET) with 15O-labeled water in 14 patients with
a reproducible history of postprandial angina and 7 matched control
subjects. The standard liquid meal precipitated angina pectoris in all
patients. Baseline whole heart blood flow was similar and increased
normally after the meal in patients (0.97±0.14 to 1.14±0.25 mL
· min-1 · g-1,
P<.04) as in control subjects (0.92±0.12 to 1.02±0.13
mL · min-1 · g-1,
P<.02). In contrast, the coefficient of variation of
blood flow increased significantly after the standard liquid meal in
patients (34±9%, P<.05 versus baseline) but not in
control subjects (17±7%, P=NS versus baseline). In
patients, analysis of regional myocardial blood flow
demonstrated decreased myocardial blood flow in territories supplied by
stenotic arteries (1.01±0.35 to 0.76±0.27 mL ·
min-1 · g-1, P<.03),
but there was an increase in blood flow in territories supplied by
normal arteries (0.89±0.16 to 1.34±0.25 mL ·
min-1 · g-1, P<.001)
after the meal.
Conclusions—The standard liquid meal induced angina
pectoris in patients with coronary artery disease. Although
whole heart blood flow increased appropriately for the greater cardiac
work, there was a redistribution of regional blood flow from
territories supplied by severely stenosed coronary arteries to
those supplied by less diseased or normal arteries. This redistribution
may be the cause of myocardial ischemia in postprandial angina.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Regional Myocardial Blood Flow Redistribution as a Cause of Postprandial Angina Pectoris
Key Words: angina • food • coronary disease • blood flow
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