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Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but "Normal" coronary angiography

B De Bruyne1, F Hersbach, N H Pijls

  • 1Cardiovascular Center Aalst, Aalst, Belgium. bernard.de.bruyne@olvz-aalst.be

Circulation
|November 14, 2001
PubMed

Insights

Diffuse coronary atherosclerosis, even without visible blockages, reduces blood flow and pressure in coronary arteries. This finding impacts understanding of myocardial ischemia and treatment decisions.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Physiology

Background:

  • Angiography often misses diffuse coronary atherosclerosis, a common process in coronary artery disease.
  • Non-obstructive coronary arteries are typically considered to have normal flow dynamics.
  • Atherosclerosis is a diffuse disease affecting the entire arterial length, not just focal stenoses.

Purpose of the Study:

  • To investigate if non-stenotic coronary arteries in patients with coronary artery disease exhibit reduced pressure and flow.
  • To quantify the pressure drop across non-obstructive coronary segments due to diffuse atherosclerosis.
  • To determine the impact of diffuse atherosclerosis on coronary conductance and fractional flow reserve (FFR).

Main Methods:

  • Measurement of coronary pressure and fractional flow reserve (FFR) in non-stenotic arteries.
  • Comparison between healthy individuals (Group I) and patients with coronary artery disease (Group II).
  • Analysis of pressure gradients at rest and during hyperemia to assess coronary resistance.

Main Results:

  • Non-stenotic arteries in patients with coronary artery disease showed significantly higher pressure gradients compared to healthy controls.
  • Fractional flow reserve (FFR) was significantly lower in non-stenotic arteries of patients with coronary artery disease, indicating increased resistance.
  • A substantial percentage of non-stenotic arteries exhibited FFR values below normal, with some reaching the threshold for inducible ischemia.

Conclusions:

  • Diffuse coronary atherosclerosis without focal stenosis causes a continuous pressure reduction along the coronary artery length.
  • This continuous pressure fall contributes to myocardial ischemia.
  • The presence of diffuse atherosclerosis in non-stenotic segments has implications for interventional cardiology decision-making.
Abstract

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