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Assessment of regional coronary flow reserve by digital angiography in patients with coronary artery disease

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Summary

Digital angiography provides a convenient means to quantify the progression of a contrast medium bolus injected into a coronary artery throughout the myocardium, which in turn yields information on myocardial perfusion. Sixteen patients presenting a single critical proximal stenosis (estimated diameter reduction >80%) on either the left anterior descending coronary artery (LAD) or the left circumflex coronary artery (LCX) were studied. First, 12 consecutive end-diastolic images of an ECG-triggered intracoronary injection of 4 ml of iopamidol were acquired on 60° left anterior oblique projection under basal conditions. This was repeated 30 s after intracoronary injection of 12 mg of papaverine. For each image sequence, a densogram was computed in each pixel by fitting a curve through its 12 consecutive intensity values. The ‘time of maximal pixel opacification’ (TMAX) and the ‘mean ascending time’ (TMAT), expressed in cardiac cycles, were determined from each curve. Two myocardial regions of interest (ROI) were defined for each patient, one in the perfusion bed of the LAD, the other in the bed of the LCX. The mean values of TMAX and TMAT in each ROI were computed, at rest and during hyperemia. At rest, the mean values of TMAX and TMAT obtained from the ROI associated to the stenosis artery were not significantly different from the values obtained in the ROI associated with the intact artery. During hyperemia, a significant decrease of the mean TMAX and TMAT was observed in the normally perfused regions (p<0.001). The rest to hyperemia ratios of both TMAX and TMAT mean values were considered to be indices of coronary flow reserve. Due to the decrease of TMAX and TMAT during hyperemia, the two indices were significantly higher in the normal ROI than in the ischemic ROI (p<0.001).

In conclusion: Intracoronary injection of papaverine produces an acceleration of blood flow in normally perfused myocardium despite the increase of vascular volume. This acceleration is absent in regions supplied by a severely stenosed coronary artery. Thus, a differentiation between normally and abnormally perfused myocardial regions is possible by use of indices of coronary flow reserve derived from time parameters of the myocardial circulation.

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Authors and Affiliations

  1. Cardiology Center, University Hospital, 24, rue Micheli-du-Crest, CH-1211, Geneva 4, Switzerland

    Bernard de Bruyne, Pierre A. Dorsaz, Pierre A. Doriot, Bernhard Meier, Leo Finci &  Wilhelm Rutishauser

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  1. Bernard de Bruyne
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  2. Pierre A. Dorsaz
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  3. Pierre A. Doriot
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  4. Bernhard Meier
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  5. Leo Finci
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  6. Wilhelm Rutishauser
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Supported by a grant of the Swiss National Science Foundation.

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de Bruyne, B., Dorsaz, P.A., Doriot, P.A. et al. Assessment of regional coronary flow reserve by digital angiography in patients with coronary artery disease. Int J Cardiac Imag 3, 47–55 (1988). https://doi.org/10.1007/BF01801644

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