(Circulation. 1998;98:1257-1260.)
© 1998 American Heart Association, Inc.
Vasodilator Reserve
A Functional Assessment of Coronary Health
Robert J. Bache, MD
From the Department of Medicine, Division of Cardiology, University of
Minnesota Medical School, Minneapolis.
Correspondence to Robert J. Bache, MD, Division of Cardiology, Department of Medicine, University of Minnesota Medical School, Box 508 UMHC, 420 Delaware St SE, Minneapolis, MN 55455. E-mail bache001@maroon.tc.umn.edu
Key Words: Editorials • cholesterol • coronary disease • endothelium • nitric oxide • vasodilation
Assessment of coronary artery
stenosis severity depends on either determination of the
anatomic dimensions of the stenosis by angiographic techniques
or assessment of the functional significance of the stenosis by
measurement of its effect on blood flow. Measurement of myocardial
blood flow during maximal pharmacological vasodilation (vasodilator
reserve) has been used to examine the functional consequences of a
stenosis on perfusion of the dependent region of
myocardium. In experimental animals, flow reserve measured
with an electromagnetic flowmeter during pharmacological
coronary vasodilation corresponds closely to quantitative
coronary angiographic measurements of stenosis
geometry.1 Studies using PET imaging with
[13N]ammonia to measure coronary flow
reserve in patients with coronary artery disease also
demonstrated an inverse correlation between stenosis severity
and flow reserve, but the relationship exhibited a greater degree of
scatter than that obtained in animal models.2 It
is not surprising that the correlation between stenosis
severity and flow reserve would be less precise in patients with
coronary disease, because atherosclerosis
introduces potential variability in the behavior of both the epicardial
stenotic segment and the coronary resistance vessels.
Thus, a coronary stenosis in a patient with
atherosclerosis may not produce a fixed degree of
anatomic narrowing of the epicardial artery, and the resistance vessels
may not predictably undergo maximal vasodilation in response to
pharmacological vasodilators. Consequently, interpretation of
coronary vasodilator reserve requires consideration of the
dynamic characteristics of both the epicardial artery segment and the
coronary resistance vessels.
Epicardial Arteries
Lundmer et al3 demonstrated that
intracoronary acetylcholine caused vasodilation in patients
with atypical chest . . . [Full Text of this Article]
This article has been cited by other articles:
|
|
|
|
 
R Montisci, L Chen, M Ruscazio, P Colonna, C Cadeddu, C Caiati, M Montisci, L Meloni, and S Iliceto
Non-invasive coronary flow reserve is correlated with microvascular integrity and myocardial viability after primary angioplasty in acute myocardial infarction
Heart,
August 1, 2006;
92(8):
1113 - 1118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Neishi, S. Mochizuki, T. Miyasaka, T. Kawamoto, T. Kume, R. Sukmawan, M. Tsukiji, Y. Ogasawara, F. Kajiya, T. Akasaka, et al.
Evaluation of bioavailability of nitric oxide in coronary circulation by direct measurement of plasma nitric oxide concentration
PNAS,
August 9, 2005;
102(32):
11456 - 11461.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Kingwell, M. Formosa, M. Muhlmann, S. J. Bradley, and G. K. McConell
Type 2 Diabetic Individuals Have Impaired Leg Blood Flow Responses to Exercise: Role of endothelium-dependent vasodilation
Diabetes Care,
March 1, 2003;
26(3):
899 - 904.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Campisi, L. Nathan, M. H. Pampaloni, H. Schoder, J. W. Sayre, G. Chaudhuri, and H. R. Schelbert
Noninvasive Assessment of Coronary Microcirculatory Function in Postmenopausal Women and Effects of Short-Term and Long-Term Estrogen Administration
Circulation,
January 29, 2002;
105(4):
425 - 430.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Kern
Coronary Physiology Revisited : Practical Insights From the Cardiac Catheterization Laboratory
Circulation,
March 21, 2000;
101(11):
1344 - 1351.
[Abstract]
[Full Text]
[PDF]
|
|
|
