Autoregulation in the stenosed coronary circulation

Coronary vessel stenosis increases vascular resistance and limits the dynamic range of autoregulation. In this study, the limitation imposed by stenosed vessels on oxygen delivery to the myocardium was investigated using a theoretical model. For different degrees of stenosis and for different levels of arteriovenous oxygen content difference, the model predicted the limits of the contractility range for which ventricular oxygen balance is positive. The model also predicted the existence of an optimal contractility level which minimizes the cost of arterial pressure generation and provides the largest coronary oxygen reserve. With severe stenosis, myocardial oxygen balance is extremely sensitive to changes in the level of stenosis. The range of contractility in which the coronary circulation can meet the myocardial oxygen needs is dramatically reduced by small increases in stenosis severity or small decreases in arteriovenous oxygen difference. When the optimal contractility level is maintained, the heart can tolerate these detrimental changes to a greater extent.