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Transmural perfusion gradients distal to various degrees of coronary artery stenosis during resting flow or at maximal vasodilation

Transmurale Durchblutungsverteilung im stenoseabhängigen Myokard unter Ruhebedingungen und bei maximaler Koronardilatation

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Summary

Regional myocardial perfusion (assessed by 15 μ tracer microspheres) was determined at various levels of stenosis of the left circumflex coronary artery in anesthetized dogs. Measurements during control and at three levels of stenosis produced by a micrometer-driven mechanical occluder were made in each heart. No change was found in the transmural distribution of coronary blood flow until 93% stenosis. At levels above 93% stenosis there was a linear decrease in subendocardial perfusion with only minor changes in subepicardial perfusion. During maximal vasodilation produced by reactive hyperemia, the decrease in subendocardial flow was observed at levels greater than 60% stenosis. It is concluded that the subendocardium of the left ventricle has a large vasodilator reserve and severe stenoses are required to disrupt flow when autoregulation is intact. When autoregulation is abolished, reduction in subendocardial flow occurs at lesser degrees of stenosis.

Zusammenfassung

Die regionale Myokarddurchblutung, mit 15 μ microspheres gemessen, wurde bei unterschiedlichen Stenosegraden des R. circumflexus der linken Koronararterie bei narkotisierten Hunden gemessen. Die Messungen wurden in Kontrolle und bei 3 Stenosegraden (mit Mikrometerschraube angetriebene mechanische Drossel) ausgeführt. Die transmurale Durchblutungsverteilung blieb unverändert bis zu einer Stenose von 93%. Oberhalb dieses Wertes sank die subendokardiale Durchblutung linear, die subepikardiale Durchblutung änderte sich nur wenig. Bei maximaler Vasodilatation (reaktive Hyperämie) wurde die Abnahme der subendokardialen Durchblutung schon bei >60% Stenose festgestellt. Es wird daraus geschlossen, daß das Subendokard eine große Vasodilatationsreserve hat und daß erst hochgradige Stenosen, die Durchblutung bei intakter Autoregulation beeinflussen. Bei ausgeschalteter Autoregulation erfolgt die Verminderung der subendokardialen Perfusion schon bei geringeren Stenosegraden.

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Author notes

  1. D. C. Warltier (fellow of the National Science Foundation)

    Present address: Department of Pharmacology, Medical College of Wisconsin, 8101 West Watertown Plank Road, 53226, Milwaukee, Wisconsin, USA

Authors and Affiliations

  1. Department of Pharmacology, Medical College of Wisconsin, 8101 West Watertown Plank Road, 53226, Milwaukee, Wisconsin, USA

    H. F. Hardman & G. J. Gross

Authors
  1. D. C. Warltier
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  2. H. F. Hardman
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  3. G. J. Gross
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Additional information

With 3 figures and 4 tables

This study was supported in part by grants from the U.S. Public Health Service HL 08311, the Wisconsin Heart Association and the Deborah Hospital Foundation.

Dr.Gross is a recipient of a Pharmaceutical Manufacturers Association Foundation Faculty Development Award.

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Warltier, D.C., Hardman, H.F. & Gross, G.J. Transmural perfusion gradients distal to various degrees of coronary artery stenosis during resting flow or at maximal vasodilation. Basic Res Cardiol 74, 494–508 (1979). https://doi.org/10.1007/BF01907643

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  • DOI: https://doi.org/10.1007/BF01907643

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