A Study of Hemodynamics and Coronary Blood Flow in Man with Coronary Artery Disease

Rowe, George G.; Thomsen, James H.; Stenlund, Roger R.; McKenna, David H.; Sialer, Salvador; Corliss, Robert J.

doi:10.1161/01.cir.39.1.139

Cited by 103 publications

(21 citation statements)

References 35 publications

(4 reference statements)

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“…The average mean LV myocardial blood flow rate of 61 ml/100 g-min in this group is similar to the value of 64 ml/100 gmin obtained previously in a series of patients with heart disease and normal coronary arteriograms who were studied at Roosevelt Hospital (6). It is similar also to control values obtained by others who measured single myocardial washout curves of '"Xe or He (2, 7), but is lower than those obtained by groups using the nitrous oxide technique (1,15,16), which has yielded a wide range of values in normal subjects (17). In the control subjects, the regional myocardial blood flow rates in the areas of LV supplied by the LAD and Circ.…”

Section: Regional Myocardial Perfusion and Coronary Arteriographic Lesupporting

confidence: 90%

“…Five groups of investigators found no significant differences in the myocardial capillary blood flow rates per gram of left ventricle (LV)1 grams and others with significant coronary disease when they monitored single myocardial washout curves of nitrous oxide or radioactive inert gases (1)(2)(3)(4)(5). In contrast, Cannon et al found average mean LV perfusion to be significantly lower in patients with two-vessel left coronary artery disease than in patients with normal left coronary arteriograms (6); they studied regional myocardial perfusion with '"Xe and a multiple-crystal scintillation camera.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between regional myocardial perfusion at rest and arteriographic lesions in patients with coronary atherosclerosis.

Cannon¹,

Schmidt²,

Weiss³

et al. 1975

J. Clin. Invest.

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AB STRA CT Measurements of mean left ventricular (LV) and regional myocardial blood flow rates were made at rest in 161 patients with '=Xe and a multiplecrystal scintillation camera. Myocardial perfusion rates were correlated with assessments of the degree of coronary artery disease made from the arteriograms obtained during the same studies. In patients with normal coronary arteries without heart failure, the presence of hypertension, aortic stenosis, or aortic insufficiency was not associated with changes in mean LV perfusion from the control value of 61±7 ml/100 g min. However, mean LV perfusion was significantly reduced in patients with normal coronary arteries who had cardiomyopathy and impaired ventricular performance. Mean LV perfusion was not significantly different from control valtues in patients with "mild" coronary artery disease (< 50% obstruction) or in patients with significant isolated disease (> 50% obstruction) of the left anterior descending (LAD) artery. Significant reductions in mean LV perfusion were found in patients with > 50% obstruction of two coronary arteries (LAD + right or LAD + circumflex) and in patients with triple-vessel disease.The average perfusion rate for regions distal to LAD obstructions in patients with isolated LAD disease was not lower than the LAD perfusion in control patients, but was significantly reduced in patients with LAD + right coronary artery disease (43±14 ml/100 g.min).In the latter group average perfusion distal to the LAD lesion was significantly lower than the average regional perfusion rate for the remainder of the LV. However, The data demonstrate that the presence of radiograplhically "mild" or significant isolated LAD coronary disease is not associated with reductions in mean LV perfusion at rest, but that mean LV perfusion is reduced in the presence of significant disease of two or three coronary arteries. None of the patients experienced angina dturing the resting studies and most had clinical evidence of ventricular failure. The observation of depressed LV perfusion in this group, as in the patients with cardiomvopathy, raises the possibility that a lowered resting blood supply may be adequate for a reduced level of per-formance of a diseased ventricle. The lack of selective reductions of regional perfusion at rest in the majority of the patients with LAD lesions suggests that regional myocardial blood flow must be measured during an intervention which increases myocardial oxygen consumption in order to assess the physiological significance of lesions which are observed at coronary arteriography.

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Section: Regional Myocardial Perfusion and Coronary Arteriographic Lesupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The relationship between regional myocardial perfusion at rest and arteriographic lesions in patients with coronary atherosclerosis.

Cannon¹,

Schmidt²,

Weiss³

et al. 1975

J. Clin. Invest.

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show abstract

“…1938 - 41 Poor reliability of readings of percent stenosis between 30% and 50% was one of the reasons that we excluded all patients with nonobstructive disease (13% of the population). The use of a consensus reading to determine the number of vessels with a greater than 50% stenosis similar to the method in our study has achieved a reliability of as high as 90%.…”

Section: Resultsmentioning

confidence: 99%

Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis.

Wofford

Kahl

Howard

et al. 1991

Arterioscler Thromb

281

142

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The extent of carotid artery atherosclerosis as measured by B-mode ultrasound has been shown to be strongly and independently correlated with the presence or absence of coronary atherosclerotic disease (CAD), but no studies to date have used carotid B-mode ultrasound to compare the extent of atherosclerotic disease in the two arterial circulations. We used data from a registry of patients undergoing cardiac catheterization and B-mode ultrasound of the carotid arteries to compare the extent of CAD (number of major coronary vessels with 50% or greater stenosis as judged by a consensus interpretation) with the extent of extracranial carotid atherosclerosis. Four hundred thirty-four patients (234 men, 200 women) greater than 40 years of age were stratified by gender and then divided into quartiles on the basis of a B-mode score that was derived by summing arterial wall thickness at nine sites in the left and nine sites in the right carotid arteries. Evaluation of extent of CAD for the four B-mode quartiles showed that men in the lowest B-mode quartile were over six times more likely to have normal coronary arteries than three-to four-vessel CAD, while men in the highest B-mode quartile were over 10 times more likely to have three-to four-vessel CAD than normal coronary arteries. The findings were similar for women but not as dramatic Gender-specific discriminant function models using traditional risk factors alone or in combination with B-mode score were developed to predict the extent of CAD. Discriminant models containing traditional risk factors alone performed only slightly better than a model that contained only the B-mode score. The addition of the B-mode score to models of traditional risk factors added little to the predictive ability for CAD extent (/Irteriosclerosis and Thrombosis 1991;11:1786-1794) E pidemiological studies have established certain factors (age, male gender, hypertension, dyslipidemia, diabetes, and smoking) as predictors of clinical manifestations of coronary artery disease (CAD).1 -3 These same risk factors have also

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“…Both normal and reduced rates of nutrient flow per gram tissue were found by investigators who externally monitored myocardial extraction of a tracer or analyzed single inert gas wash-out curves from heart muscle with precordial detectors or by coronary sinus sampling (8)(9)(10)(11). Studies using H2 provided evidence that myocardial blood flow was more heterogeneous than normal in coronary patients (12); however regional flow reductions were not quantitated in these studies.…”

Section: Introductionmentioning

confidence: 98%

Regional Myocardial Perfusion Rates in Patients with Coronary Artery Disease

Cannon¹,

Dell²,

Dwyer³

1972

J. Clin. Invest.

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A B S T R A C T Regional myocardial perfusion rates were estimated from the myocardial washout of 'lXenon in 24 patients with heart disease whose coronary arteriograms were abnormal and 17 similar subjects whose coronary arteriograms were judged to be normal. Disappearance rates of 'Xe from multiple areas of the heart were monitored externally with a multiple-crystal scintillation camera after the isotope had been injected into a coronary artery and local myocardial perfusion rates were calculated by the Kety formula.The mean myocardial perfusion rates in the left ventricle exceeded those in the right ventricle or atrial regions in subjects without demonstrable coronary artery disease. In this group there was a significant lack of homogeneity of local perfusion rates in left ventricular myocardium; the mean coefficient of variation of left ventricular local perfusion rates was 15.8%.In normal; in seven subjects of this group perfusion of the inferior left ventricle by a dominant right coronary artery was absent or depressed. The average mean left ventricular perfusion rate of 12 subjects with significant disease of two or more branches of the left coronary artery was significantly lower than that of the group with normal left coronary arteriograms. In the patients with abnormal left coronary arteriograms, the average coefficient of variation of local left ventricular perfusion rates was significantly increased (24.8%). The studies provide evidence that coronary artery disease is associated with increased heterogeneity of local myocardial perfusion rates. They indicate that radiographically significant vascular pathology of the right or left coronary artery may be associated with significant reductions of myocardial capillary perfusion in the region supplied by the diseased vessel.

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A Study of Hemodynamics and Coronary Blood Flow in Man with Coronary Artery Disease

Cited by 103 publications

References 35 publications

The relationship between regional myocardial perfusion at rest and arteriographic lesions in patients with coronary atherosclerosis.

The relationship between regional myocardial perfusion at rest and arteriographic lesions in patients with coronary atherosclerosis.

Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis.

Regional Myocardial Perfusion Rates in Patients with Coronary Artery Disease

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