(Circulation. 1995;92:342-347.)
© 1995 American Heart Association, Inc.
Articles |
Relation Between Diastolic Perfusion Time and Coronary Artery Stenosis During Stress-Induced Myocardial Ischemia
From the Department of Internal Medicine, Division of Cardiology, Federico II University, Naples, Italy.
Correspondence to Giuseppe Ferro, MD, Via Pezzullo 30, 80027 Frattamaggiore, Naples, Italy.
Background Experimental studies have demonstrated that during stress-induced myocardial ischemia, coronary obstruction and diastolic perfusion time are factors that limit subendocardial perfusion and correlate to degree of myocardial dysfunction. The relation between these two factors has not yet been investigated in humans. The aim of the present study was to assess the relation between diastolic perfusion time and degree of coronary stenosis during different types of stress tests.
Methods and Results Nine patients with isolated and proximal stenosis of the left anterior descending coronary artery were selected. Patients underwent three different randomized stress tests (upright, supine bicycle stress test, and transesophageal atrial pacing). Diastolic perfusion time, heart rate (RR interval), and systolic and diastolic pressures were measured during the test and at the ischemic threshold (0.1-mV ST-segment depression). Angiographic measurements of coronary stenosis were evaluated by quantitative coronary angiography. At the ischemic threshold, significant differences among tests were found in heart rate (P<.05), systolic pressure (P<.001), and diastolic pressure (P<.05). In each stress test, diastolic perfusion time at the ischemic threshold was closely correlated with minimal stenosis diameter (r=.97; P<.001) and percent diameter stenosis (r=.92; P<.001) with no difference among the tests. In contrast, heart rate, rate-pressure product, and time to ischemic threshold were not significantly correlated with percent diameter stenosis and minimal stenosis diameter. No significant correlation was observed at the ischemic threshold between diastolic perfusion time and corresponding values of heart rate, despite the close correlation at rest (r=.95; P<.001).
Conclusions Despite differences in associated hemodynamic responses to various stress tests, a close relation exists between stenosis severity and diastolic perfusion time at the onset of stress-induced myocardial ischemia. Therefore, diastolic perfusion time at the ischemic threshold may be an indirect estimate of the hemodynamic significance of coronary stenosis.
Key Words: perfusion • myocardium • stress • stenosis • ischemia
This article has been cited by other articles:
 |
|
 |
|
  M. F O'Rourke How stiffening of the aorta and elastic arteries leads to compromised coronary flow Heart, June 1, 2008; 94(6): 690 - 691. [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. O'Rourke Arterial aging: pathophysiological principles Vascular Medicine, November 1, 2007; 12(4): 329 - 341. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Heusch and R. Schulz The role of heart rate and the benefits of heart rate reduction in acute myocardial ischaemia Eur. Heart J. Suppl., September 1, 2007; 9(suppl_F): F8 - F14. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. O'Rourke and J. Hashimoto Mechanical Factors in Arterial Aging: A Clinical Perspective J. Am. Coll. Cardiol., July 3, 2007; 50(1): 1 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Saha and M. S. Marber If at first you don't succeed try ... a new target in the treatment of angina Eur. Heart J., December 1, 2005; 26(23): 2482 - 2483. [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Fokkema, J. W. G. E. VanTeeffelen, S. Dekker, I. Vergroesen, J. B. Reitsma, and J. A. E. Spaan Diastolic time fraction as a determinant of subendocardial perfusion Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2450 - H2456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Barbato, Q.-Q. Huang, M. M. Hossain, M. Bond, and J.-P. Jin Proteolytic N-terminal Truncation of Cardiac Troponin I Enhances Ventricular Diastolic Function J. Biol. Chem., February 25, 2005; 280(8): 6602 - 6609. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Knaapen, L. M.C. van Campen, C. C. de Cock, M. J.W. Gotte, C. A. Visser, A. A. Lammertsma, and F. C. Visser Effects of Cardiac Resynchronization Therapy on Myocardial Perfusion Reserve Circulation, August 10, 2004; 110(6): 646 - 651. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Gould and B. A. Carabello Why Angina in Aortic Stenosis With Normal Coronary Arteriograms? Circulation, July 1, 2003; 107(25): 3121 - 3123. [Full Text] [PDF]
|
|
|
|
|
|
K. Rajappan, O. E. Rimoldi, P. G. Camici, N. G. Bellenger, D. J. Pennell, and D. J. Sheridan Functional Changes in Coronary Microcirculation After Valve Replacement in Patients With Aortic Stenosis Circulation, July 1, 2003; 107(25): 3170 - 3175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Shin, K. Hashizume, Y. Iino, K. Koizumi, T. Matayoshi, and R. Yozu Effects of atrial fibrillation on coronary artery bypass graft flow Eur. J. Cardiothorac. Surg., February 1, 2003; 23(2): 175 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Colin, B. Ghaleh, X. Monnet, J. Su, L. Hittinger, J.-F. Giudicelli, and A. Berdeaux Contributions of heart rate and contractility to myocardial oxygen balance during exercise Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H676 - H682. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Rajappan, O. E. Rimoldi, D. P. Dutka, B. Ariff, D. J. Pennell, D. J. Sheridan, and P. G. Camici Mechanisms of Coronary Microcirculatory Dysfunction in Patients With Aortic Stenosis and Angiographically Normal Coronary Arteries Circulation, January 29, 2002; 105(4): 470 - 476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F O'Rourke Basis and implications of change in arterial pressure with age Vascular Medicine, November 1, 2000; 5(4): 209 - 211. [PDF]
|
|
|
|
|
|
L.A. Pierard Evaluating risk in unstable angina: role of pharmacological stress echocardiography Eur. Heart J., July 1, 2000; 21(13): 1041 - 1043. [PDF]
|
|
|
|
|
|
P. Colonna, R. Montisci, L. Galiuto, L. Meloni, and S. Iliceto Effects of Acute Myocardial Ischemia on Intramyocardial Contraction Heterogeneity : A Study Performed with Ultrasound Integrated Backscatter During Transesophageal Atrial Pacing Circulation, October 26, 1999; 100(17): 1770 - 1776. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Domanski, G. F. Mitchell, J. E. Norman, D. V. Exner, B. Pitt, and M. A. Pfeffer Independent prognostic information provided by sphygmomanometrically determined pulse pressure and mean arterial pressure in patients with left ventricular dysfunction J. Am. Coll. Cardiol., March 15, 1999; 33(4): 951 - 958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, L. A. Moye, E. Braunwald, J.-L. Rouleau, V. Bernstein, E. M. Geltman, G. C. Flaker, M. A. Pfeffer, and f. t. S. Investigators Sphygmomanometrically Determined Pulse Pressure Is a Powerful Independent Predictor of Recurrent Events After Myocardial Infarction in Patients With Impaired Left Ventricular Function Circulation, December 16, 1997; 96(12): 4254 - 4260. [Abstract] [Full Text]
|
|
|
|
|
|
K. L. Gould Why Angina Pectoris in Aortic Stenosis Circulation, February 18, 1997; 95(4): 790 - 792. [Full Text]
|
|