From the Institut für Herz- und Kreislaufphysiologie (R.L.) and the
Institut für Klinische Anästhesiologie (C.W.F.),
Heinrich-Heine-Universität Düsseldorf, and the Institut für
Physiologie, Medizinische Fakultät Carl Gustav Carus der Technischen
Universität Dresden (A.D.), Germany.
Correspondence to Dr Andreas Deussen, Professor and Chairman, Institut für Physiologie, Medizinische Fakultät Carl Gustav Carus der Technischen Universität Dresden, Fetscherstr 74, D-01307 Dresden, Germany.
Background—Left
ventricular myocardial blood flow is spatially
heterogeneous. The hypothesis we tested was whether
myocardial areas with a steady-state flow <0.5 times mean flow are
underperfused and areas with flow >1.5 times mean flow are
overperfused.
Methods and Results—In anesthetized beagle dogs (n=10),
the relationship between local blood flow versus
S-adenosylhomocysteine (SAH) concentration, a
measure of the free intracellular adenosine concentration, and
lactate, a measure of the myocardial NADH/NAD+ ratio, were
determined under control conditions and after coronary
constriction. Control local myocardial blood flow was 0.99±0.46
mL · min-1 · g-1, with a
coefficient of variation of 0.36±0.12 (n=256 per heart; sample wet
mass, 125±30 mg). Tissue concentrations of SAH (3.4±2.5 nmol/g) and
lactate (1.88±0.80 µmol/g) were not elevated in low-flow
samples. However, after coronary artery constriction,
poststenotic blood flow decreased from 1.00±0.27 to 0.49±0.22
mL · min-1 · g-1
(P<0.04), with significant correlation between local
SAH and flow (r=-0.59) and lactate and flow
(r=-0.50). Although nearly all samples from control
high-flow regions showed increased SAH concentrations if relative flow
after stenosis was <1.0, control low-flow samples frequently
displayed low SAH concentrations. The percent reduction in flow
determined the changes in the local SAH and lactate concentration,
independent of the local control blood flow.
Conclusions—When the coronary inflow is unrestricted, the
oxygen supply to control low-flow regions meets metabolic
demand. Flow to control high-flow regions reflects a higher local
demand rather than overperfusion. Thus, blood flow
heterogeneity most likely reflects differences in
aerobic metabolism.
© 1998 American Heart Association, Inc.
Basic Science Reports
Coronary Reserve of High- and Low-Flow Regions in the Dog Heart Left Ventricle
Key Words: blood flow • homocysteine • microspheres • perfusion
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