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Saline-Induced Coronary Hyperemia: Mechanisms and Effects on Left Ventricular Function
Bernard De Bruyne1, Julien Adjedj2, Panagiotis Xaplanteris2
1From the Cardiovascular Center Aalst, Belgium (B.D.B., J.A., P.X., A.F., Y.M., M. Penicka, V.F., M. Pellicano, E.B.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (M. Pellicano, E.B.); University Heart Centre Graz, Austria (G.T.); Experimental Cardiology, Thoraxcenter, Erasmus University Rotterdam, The Netherlands (D.J.D.); Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands (N.H.J.P.); and Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands (N.H.J.P.). bernard.de.bruyne@olvz-aalst.be.
Intracoronary saline infusion induces maximal hyperemia, comparable to adenosine, at rates of 15 mL/min or higher. This provides a new method for measuring coronary blood flow and microcirculatory resistance.
Area of Science:
- Cardiovascular Physiology
- Interventional Cardiology
- Diagnostic Techniques
Background:
- Observational data suggested intracoronary saline infusion increases coronary blood flow during thermodilution.
- The precise extent and mechanisms of this saline-induced hyperemia were not fully understood.
Purpose of the Study:
- To quantify the hyperemia induced by intracoronary saline infusion.
- To investigate the underlying mechanisms of saline-induced hyperemia.
Main Methods:
- Intracoronary Doppler flow velocity measurements were performed in patients receiving increasing rates of room temperature saline infusion.
- Coronary flow reserve was compared between saline and adenosine administration.
- Echocardiography assessed cardiac function during saline infusion.
Main Results:
- Saline infusion at 15-20 mL/min induced maximal hyperemia, achieving 111-112% of adenosine-induced levels.
- Saline- and adenosine-induced coronary flow reserve showed high agreement (ICC=0.922).
- Saline infusion did not significantly alter blood pressure or left ventricular function but decreased heart rate by 15%.
Conclusions:
- Intracoronary saline infusion at ≥15 mL/min reliably induces steady-state maximal hyperemia.
- This method offers a novel approach for assessing maximal absolute coronary blood flow and minimal microcirculatory resistance.