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Published on: February 16, 2016
Coronary blood flow reserve measured by contrast media injection depends on myocardial viability
G Drobinski1, G Montalescot, N Moussallem
1Service de Cardiologie, CHU Pitié-Salpétrière, Paris, France.
Insights
Coronary blood flow reserve is reduced in areas with myocardial infarction scars. This suggests that impaired coronary blood flow is linked to the lasting effects of ischemic cell death.
Area of Science:
- Cardiology
- Physiology
Background:
- Coronary blood flow reserve is crucial for myocardial function.
- Physiological variables beyond hydraulic impedance can influence coronary blood flow.
- Myocardial infarction can lead to chronic scar tissue, potentially affecting coronary flow dynamics.
Purpose of the Study:
- To investigate the hyperemic response in non-stenotic coronary arteries supplying myocardial scar tissue.
- To assess the impact of chronic myocardial infarction scar on coronary blood flow reserve.
- To determine if myocardial metabolic stimulus is impaired by ischemic cell death.
Main Methods:
- Utilized a steerable pulsed Doppler system to record flow velocities.
- Administered hyperosmolar radiopaque contrast medium to induce hyperemia.
- Compared hyperemic responses in the left anterior descending and left circumflex arteries in four patients with Q wave anterior myocardial infarction.
Main Results:
- Resting flow velocities were similar between the left anterior descending and circumflex arteries.
- The hyperemic response in the circumflex artery (2.23 +/- 0.75) was significantly greater than in the left anterior descending artery (1.22 +/- 0.15).
- Contrast media-induced hyperemia was reduced in the left anterior descending artery supplying the scar compared to the circumflex artery.
Conclusions:
- Non-stenotic coronary arteries supplying post-myocardial infarction chronic scar exhibit a decreased hyperemic response.
- Coronary blood flow reserve is dependent on a myocardial metabolic stimulus.
- Ischemic cell death associated with myocardial infarction impairs this metabolic stimulus, reducing coronary blood flow reserve.
Abstract:
Coronary blood flow reserve may be affected by several physiological variables besides hydraulic impediment to flow. A hyperaemic response induced by hyperosmolar radiopaque contrast medium was recorded in the left anterior descending and left circumflex arteries with a steerable pulsed Doppler system in four patients with Q wave anterior myocardial infarction chronic scar and non-stenotic coronary arteries. Resting flow velocities were similar in both arteries. The magnitude of the hyperaemic response induced by contrast media in the circumflex artery (mean flow velocity increase from 5.9 +/- 2.5 baseline to 12.2 +/- 0.6 cm s-1 at peak flow, P less than 0.05) was almost twice that induced in the left anterior descending artery (mean flow velocity increase from 6.1 +/- 2.2 baseline to 7.4 +/- 2.6 cm s-1 at peak flow, P = N.S.). The peak flow to baseline flow velocities ratios were 1.22 +/- 0.15 in the left anterior descending artery vs 2.23 +/- 0.75 in the circumflex artery. Thus when a post-myocardial infarction chronic scar is supplied by a non-stenotic coronary artery, the coronary blood flow hyperaemic response to contrast media-induced transient ischaemia is decreased, suggesting that coronary blood flow reserve depends on a myocardial metabolic stimulus which is impaired by ischaemic cell death.
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