Measuring Regional Myocardial Blood Flow with<sup>133</sup>Xe and the Anger Camera

Holman, B. Leonard; Adams, Douglass F.; Jewitt, D. E.; Eldh, Per; Idoine, John; Cohn, Peter F.; Gorlin, Richard; Adelstein, S. James

doi:10.1148/112.1.99

Cited by 56 publications

(15 citation statements)

References 16 publications

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“…Also, the xenon 133 washout technique may be inaccurate when coronary blood flow exceeds 200 ml/min/100 gr. 25 Administration of low-dose intravenous nitroglycerin during measurements of coronary vasodilator reserve might have decreased myocardial oxygen consumption and thereby produced small decreases in resting coronary blood flow. The dose of nitroglycerin used (8 ,g/min), however, rarely results in hemodynamic alterations and should not evoke a change in resting coronary blood flow via reduced oxygen consumption.27 Conversely, low-dose intravenous nitroglycerin might have increased resting coronary blood flow velocity and thereby decreased the peak/resting velocity ratio.…”

mentioning

confidence: 99%

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.

Wilson¹,

White²

1986

Circulation

360

118

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An ideal coronary vasodilator for studying coronary flow reserve in humans would rapidly produce maximal coronary vasodilation, be short acting to permit repeated measurements, and not alter systemic hemodynamics. The two commonly used vasodilators (dipyridamole and meglumine diatrizoate) do not satisfy these criteria; meglumine diatrizoate does not produce maximal hyperemia and dipyridamole has a long duration of effect (greater than 30 min). In this study we used a subselective coronary Doppler catheter to measure the dose-response kinetics of a shorter acting vasodilator, intracoronary papaverine. In 10 patients with normal coronary vessels, the maximal vasodilator response to papaverine was compared with that to intravenous dipyridamole (0.56 mg/kg infused over 4 min) and intracoronary meglumine diatrizoate. The increase in coronary blood flow velocity after the maximal dose of papaverine (4.8 ± 0.4 peak/resting velocity ratio, mean ± SEM) was nearly identical to that seen after infusion of dipyridamole (4.8 + 0.6) and was significantly greater than that after meglumine diatrizoate (3.1 ± 0.2, p < .01). At maximal hyperemia, mean arterial blood pressure fell 9 + 2% (mean + SEM) after intracoronary papaverine, 8 + 4% after dipyridamole, and 3 + 3% after meglumine diatrizoate. The dose-response kinetics of intracoronary papaverine were studied in 13 patients with normal coronary arteries. In the left coronary artery, maximal vasodilation (5.4 ± 0.6) was achieved with 8 mg in six of eight patients and with 12 mg in all patients. In the right coronary artery, maximal vasodilation (4.8 ± 0.7) was achieved with 6 mg in four or five patients and with 8 mg in all patients. Onset of maximal vasodilation was rapid after papaverine (16 + 1 sec) and meglumine diatrizoate (15 ± 1), but prolonged after dipyridamole (4.8 ± 0.4 min after onset of infusion). The duration of maximal vasodilation was brief after papaverine (49 + 10 sec) and meglumine diatrizoate (8 ± 1 sec), but prolonged after dipyridamole (greater than 4 min). Coronary blood flow velocity returned to within 10% of resting values quickly after papaverine (128 ± 15 sec) and meglumine diatrizoate (42 ± 4 sec). After dipyridamole infusion, however, coronary blood flow velocity remained elevated for greater than 4 min after completion of infusion. These results suggest that papaverine can produce intense, rapid-acting vasodilation of the coronary arteriolar bed equivalent to that stimulated by intravenous dipyridamole without markedly altering systemic arterial pressure. Although the extent and duration of vasodilation was dose dependent, the hyperemic period in all patients was sufficiently brief to allow multiple measurements of coronary reserve over a short period of time. The use of intracoronary papaverine to measure the maximal flow reserve capacity of individual coronary vessels should greatly facilitate studies of the coronary circulation in patients undergoing cardiac catheterization

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confidence: 99%

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.

Wilson¹,

White²

1986

Circulation

360

118

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“…1). The position of these vessels was determined from the initial frames of the gamma camera image during the arterial phase of the study and myocardial blood flow was calculated from the initial slope of the xenon clearance curve (Ross et al, 1964;Cannon, Dell, and Dwyer, 1972b;Holman et al, 1974). To minimize possible effects of fat or other non-muscular components of myocardium on the blood flow calculation, only the slope of the curve representing the first 40 seconds of washout data was computed using a non-weighted monoexponential least squares programme, and the standard deviation of the slope was calculated.…”

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confidence: 99%

“…flow in ml/min per 100 g was determined, using the equation lO0ki F/W= p where k was the mean slope calculated from 0 to 40 seconds, X was the blood/tissue partition coefficient (assumed to be 0 72), and p was the specific gravity (assumed to be 1 05). During our initial investigation of the accuracy and sensitivity of this technique (Holman et al, 1974), 3 patients underwent reproducibility studies comparing the initial slopes of xenon washout; the mean difference in quadrant blood flow between the two runs was 3 0 ml/min per 100 g (3.8%) and the standard deviation was 3-2 ml/min per 100 g (4.0%). The correlation coefficient for quadrantic flows from run 1 compared with run 2 was 0-971.…”

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confidence: 99%

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

See¹,

Cohn²,

Holman³

et al. 1976

Heart

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The relation between alterations in regional myocardial blood flow and angiographic abnormalities of the coronary arteries and left ventricle remains unclear (Cannon, Dell, and Dwyer, 1972a;Klocke et al., 1974). In the present study, we have approached this problem by measuring whole heart blood flow and regional myocardial blood flow simultaneously, and by noting (1) to what extent regional flow is reduced in areas of abnormal left ventricular wall motion (asynergy) and (2) what the relation of this flow reduction is to the degree of

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“…Myocardial blood flow rates are computed by the Kety formula, using an assumed blood-myocardial partition coefficient. A similar approach has been used by Maseri et al 20 and Holman et al 21 To date, the xenon washout technique is the most accurate method for determining the absolute changes in flow in regions of ischemia. This technique can be applied to assess coronary reserve in man during exercise, 22 rapid atrial pacing, 21 and the induction of contrast hyperemia.…”

Section: Discussionmentioning

confidence: 99%

Assessment of regional myocardial blood flow and regional fractional oxygen extraction in dogs, using 15O-water and 15O-hemoglobin.

Parker

Hoop²,

Holman³

et al. 1978

Circulation Research

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Measuring Regional Myocardial Blood Flow with¹³³Xe and the Anger Camera

Cited by 56 publications

References 16 publications

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.

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

Assessment of regional myocardial blood flow and regional fractional oxygen extraction in dogs, using 15O-water and 15O-hemoglobin.

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Measuring Regional Myocardial Blood Flow with133Xe and the Anger Camera

Cited by 56 publications

References 16 publications

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.

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

Assessment of regional myocardial blood flow and regional fractional oxygen extraction in dogs, using 15O-water and 15O-hemoglobin.

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Measuring Regional Myocardial Blood Flow with¹³³Xe and the Anger Camera