Angiographic abnormalities associated with alterations in regional myocardial blood flow in coronary artery disease.

See, Jackie R.; Cohn, Peter F.; Holman, B. Leonard; Roberts, Barbara H.; Adams, Douglass F.

doi:10.1136/hrt.38.12.1278

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…In general, patients with this syndrome have higher flow rates than patients with angiographically documented coronary artery disease (Holman et al, 1974;Cannon et al, 1975;Holman et al, 1976;See et al, 1976;Cohn et al, 1977). Within our present study group, we could not find significant differences in flow rates between the patients with less typical anginal patterns compared with those with more typical angina patterns.…”

Section: Discussioncontrasting

confidence: 60%

“…One patient in group 1 (case 4) had From previous experience in our laboratory, any significant inferoapical hypokinesis, the remainder regional abnormalities in the distribution of blood of the ventricle being quite vigorous. Two patients flow would be most obvious in these quadrants (Holman et al, 1974;Holman et al, 1976;See et al, 1976;Cohn et al, 1977). As indicated in the Table, blood flow measurements showed a wide range of values with whole heart blood flow ranging from 41 to 128 ml/min per 100 g, and an average flow of 77 ml/min per 100 g ± 7 (SEM).…”

Section: Exercise Tolerance Testsmentioning

confidence: 90%

“…The selective intracoronary injection of xenon-133, with subsequent measurements of radioisotope washout, has proved to be a clinically reliable and reproducible method of demonstrating regional heterogeneity of coronary blood flow corresponding to anatomically demonstrable lesions in patients with coronary artery disease (Holman et al, 1974;Cannon et al, 1975;Holman et al, 1976;See et al, 1976;Cohn et al, 1977). Cannon et al (1975) have recently discussed in detail the limitations of the technique.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously described in detail the methods used in our laboratory (Holman et al, 1974;See et al, 1976;Cohn et al, 1977). Briefly, with the patient in the left anterior oblique position, 20 to 25 mCi of xenon-133 in 1 to 2 ml saline was injected through a Judkins catheter positioned in the left main coronary artery, and then rapidly flushed with 3 ml saline so as to enter the coronary circulation as a bolus.…”

Section: Regional Myocardial Specific Blood Flow Measurementsmentioning

confidence: 99%

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Regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms.

Green¹,

Cohn²,

Holman³

et al. 1978

Heart

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To evaluate possible disorders of regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms, we studied 21 patients with intracoronary injections of Xenon-133. Thirteen patients were restudied during an intervention: 6 patients received glyceryl trinitrate and 7 patients had contrast agent-induced hyperaemia. Patients were divided into 3 clinical groups: 7 patients had classic angina, 7 patients had a mixture of typical and atypical chest pain, and 7 patients had entirely atypical pain. A wide range of normal values for regional myocardial blood flow at rest was noted (41 to 128 ml/min per 100 g, with an average regional myocardial blood flow of 77 ml/min per 100 g ± 7 (mean ± SEM)). There were no significant differences between the 3 groups.With contrast hyperaemia, regional myocardial blood flow increased 164 per cent, while with glyceryl trinitrate, it decreased 31 per cent. Again, there was no statistical difference among the groups. Regional abnormalities offlow (> 15% difference between distal quadrants) were noted in 3 of 34 measurements. Two patients had heterogeneity of flow at rest by quadrant analysis but no focal perfusion abnormalities detected by functional imaging. Interestingly, both patients had positive exercise tests. Another patient had regional differences only during contrast-induced hyperaemia. Our findings suggest that most patients with chest pain syndromes and normal coronary arteriograms-even those with classic angina-do not have significant measurable myocardial perfusion abnormalities.The pathophysiology of angina pectoris is usually related to myocardial ischaemia secondary to significant luminal obstruction of the proximal coronary arteries (Zoll et al., 1951). Occasionally, however, patients will present with the typical or quasi-typical symptoms of angina, yet have entirely normal coronary arteriograms and no other recognised cause of myocardial ischaemia (valvular heart disease, hypertension, arteritides, etc.). Some patients with typical (and even atypical) angina may also have evidence of abnormal myocardial function compatible with ischaemia-such as myocardial lactate production with stress (Arbogast and Bourassa, 1972;Boudoulas et al., 1974) and electrocardiographic ST segment depression on exercise testing (Dwyer et al., 1969;Kemp et al., 1973)-others show abnormal left ventricular performance-such as a rise in left 'Supported by USPHS Grants.

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Section: Discussioncontrasting

confidence: 60%

Section: Exercise Tolerance Testsmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Regional Myocardial Specific Blood Flow Measurementsmentioning

confidence: 99%

See 2 more Smart Citations

Regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms.

Green¹,

Cohn²,

Holman³

et al. 1978

Heart

Self Cite

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Comparison between regional myocardial blood flow measurements and results of exercise tests

Roberts

Cohn

Holman

et al. 1977

Cathet. Cardiovasc. Diagn.

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The relationship between regional myocardial blood flow and the results of exercise tests were evaluated in 54 patients, 40 of whom had angiographically demonstrated coronary artery disease (CAD) and 14 had normal angiograms. After 20 patients had 2-step tests, 20 had bicycle ergometry, and 14 had treadmill tests, regional myocardial specific blood flow (RMBF) at rest was determined by selective injections of xenon-133 into the left coronary artery and quadrantic washout measured with an Anger camera. RMBF (ml/min/100 gm, mean +/- SE) was significantly lower in patients with coronary artery disease (72 +/- 3) than in normals (91 +/- 7, p less than .05) but RMBF in 12 CAD patients with negative exercise tests (75 +/- 6) was similar to regional myocardial blood flow in 28 coronary artery disease patients with positive exercise tests (71 +/- 4). Degree of ST depression did not influence results. Although measurement of RMBF and exercise testing are both useful procedures in the evaluation of patients with CAD, the data in the present study indicate the RMBF measurements at rest cannot predict the result of the postexercise ECG and vice versa.

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Pathophsiology of Coronary Artery Disease in Humans

Cohn¹,

Vokonas²

1985

Diagnosis and Therapy of Coronary Artery Disease

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Angiographic abnormalities associated with alterations in regional myocardial blood flow in coronary artery disease.

Cited by 11 publications

References 18 publications

Regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms.

Regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms.

Comparison between regional myocardial blood flow measurements and results of exercise tests

Pathophsiology of Coronary Artery Disease in Humans

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