Towards measurement of coronary blood flow in patients and its alteration by interventions

Abstract

Aim Several methods of measuring coronary blood flow in intact conscious man are reviewed, on the basis of personal contributions or the experiences of our teams. Methods and ResultsIt is important to distinguish between global, regional and transmural blood flow measurements. The advantages and limitations of the following methods are discussed: diffusible inert and radioactive tracers, dye dilution, roentgendensitometry, magnetic resonance imaging and contrast echocardiography. In interventional cardiology it is most important to be able to measure flow through single coronary vessels. Information on coronary artery Doppler velocity during vasodilation and at rest is less useful than the concept of fractional flow reserve. This is based on pressure measurements under maximal vasodilation to ascertain the presence of borderline flow-limiting lesions. This information is necessary in order to decide whether to proceed with angioplasty or not. ConclusionsThe historical design of percutaneous coronary angioplasty and beta-irradiation of coronary restenosis, established under the author's guidance, are put into perspective. The author pays tribute to many excellent colleagues who worked with him at

Estimation of coronary artery hyperemic blood flow based on arterial lumen volume using angiographic images

“…Echocardiography, after intravenous injection of microbubble contrast agent, is another noninvasive imaging modality that has been used to quantify myocardial perfusion. However, these alternative methods pose significant challenges and require further development to be clinically useful [38]. …”

X-ray videodensitometric methods for blood flow and velocity measurement: A critical review of literature

“…131,135 Despite these problems, the indicator-dilution method saw wide use for dye-based blood flowmetry purposes. 21,136,137 The introduction of the analog videodensitometer and later, digital x-ray imaging allowed the method to be applied to x-ray angiograms. 11,138,139 The resulting x-ray method was used to measure blood flow velocity in human carotid arteries, 138,[140][141][142][143][144][145][146] canine 147 and human coronary, 148 femoral and other major arteries, 135,139,[149][150][151][152] in in vitro flow phantoms 83,150,152,153 and to measure regional coronary blood flow in dogs 38,39 and humans.…”

“…19 Bursch and Heintzen 20 reviewed the use of bolus transport time algorithms. Rutishauser 21 overviewed work on videodensitometric blood flow measurement performed at Zurich and Geneva University hospitals. Overviews of developments in research and applications of videodensitometry for flow measurement in 1960s, 1970s and early 1980s with references to many works of German researchers can be also found in collections.…”

Physiology and Pathophysiology of Coronary Circulation

“…While visual angiographic assessment and even quantitative measurements appear weak methods to assess the severity of a stenosis, the method now considered most reliable to assess the hemodynamic significance of coronary stenosis (Rutishauser 1999) is the measure of fractional flow reserve (FFR) (De Bruyne et al 1994). FFR is calculated as the ratio between the mean pressures distal and proximal to the stenosis during maximal vasodilatation, usually obtained by intracoronary adenosine.…”