Coronary flow reserve is supranormal in endurance athletes: an adenosine transthoracic echocardiographic study

Abstract

Objective-To compare coronary flow reserve in endurance athletes and healthy sedentary controls, using adenosine transthoracic echocardiography. Methods-29 male endurance athletes (mean (SD) age 27.3 (6.6) years, body mass index (BMI) 22.1 (1.9) kg/m 2 ) and 23 male controls (age 27.2 (6.1) years, BMI 23.9 (2.6) kg/m 2 ) with no coronary risk factors underwent transthoracic echocardiographic assessment of distal left anterior descending coronary artery (LAD) diameter and flow, both at rest and during intravenous adenosine infusion (140 µg/kg/min). Results-Distal LAD diameter and flow were adequately assessed in 19 controls (83%) and 26 athletes (90%). Distal LAD diameter in athletes (2.04 (0.25) mm) was not significantly greater than in sedentary controls (1.97 (0.27) mm). Per cent increase in LAD diameter following 400 µg sublingual nitrate was greater in the athletes than in the controls, at 14.1 (7.2)% v 8.8 (5.7)% (p < 0.01). Left ventricular mass index in athletes exceeded that of controls, at 130 (19) v 98 (14) g/m 2 (p < 0.01). Resting flow among the athletes (10.6 (3.1) ml/min; 4.4 (1.2) ml/min/100 g left ventricular mass) was less than in the controls (14.3 (3.6) ml/min; 8.2 (2.2) ml/min/100 g left ventricular mass) (both p < 0.01). Hyperaemic flow among the athletes (61.9 (17.8) ml/min) exceeded that of the controls (51.1 (14.6) ml/min; p = 0.02), but not when corrected for left ventricular mass (25.9 (5.6) v 28.5 (7.4) ml/min/100 g left ventricular mass; NS). Coronary flow reserve was therefore substantially greater in the athletes than in the controls, at 5.9 (1.0) v 3.7 (0.7) (p < 0.01). Conclusions-Coronary flow reserve in endurance athletes is supranormal and endothelium independent vasodilatation is enhanced. Myocardial hypertrophy per se does not necessarily impair coronary flow reserve. Adenosine transthoracic echocardiography is a promising technique for the investigation of coronary flow reserve. (Heart 2000;84:383-389)

Disturbed Coronary Hemodynamics in Vessels With Intermediate Stenoses Evaluated With Fractional Flow Reserve

“…At a difference with FFR, CFR has a large inter-individual variability, influenced by age, sex, and physical training among other factors. 31,32 IMR measurements suggest that MCD was absent in group A vessels, supporting previous observations based on Doppler-derived microcirculatory resistance in the same FFR/CFR classification quadrant. 25 Because normal CFR values in group A vessels suggests adequate myocardial blood supply, the benefit of revascularization of epicardial stenoses, despite abnormal FFR, might be challenged.…”

Reserva de fluxo coronariano na anemia falciforme

“…In these situations, a proportional growth would occur between the coronary microvasculature and myocyte hypertrophy. Additionally, in humans, a result similar to that of the present study was observed in athletes with left ventricular hypertrophy 36 . These data suggest that the specificity of the inducing stimulus is important to the development of cardiac hypertrophy, and some of them are also able to induce a physiologic adaptation of the coronary microvasculature.…”

Myocardial perfusion reserve in adults with cyanotic congenital heart disease

“…This differs significantly from observations made previously in patients with acquired hypertrophy due to hypertensive or valvular heart disease (1,9,18,48), in which basal perfusion measurements were normal and hyperemic myocardial perfusion and perfusion reserves were decreased relative to controls. Our observations regarding hyperemic perfusion in the CCHD patients more closely parallel those made in those with the hypertrophy of the "athlete's" heart, in which hyperemic perfusion and perfusion reserves are preserved (21,26). These observations suggest that there may be significant differences in the pathogenesis and pathophysiology of the increase in ventricular mass between CCHD patients and those with acquired forms of ventricular hypertrophy (hypertensive or valvular heart disease).…”