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Functional Neuroimaging of Angina Pectoris

  • Chapter
Advanced Imaging In Coronary Artery Disease

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 202))

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Abstract

In the normal heart, both intrinsic mechanisms (such as coronary vascular autoregulation and Starling mechanical properties) and extrinsic (mainly neurohumoral) influences allow adaptation to a wide range of demand for output of blood 1. Even under resting conditions, oxidative metabolism is crucial to function of the heart, indeed mitochondria comprise 1/3 of the mass of the myocardial cells. Oxygen extraction is near maximal even under resting conditions at 60–70%, and is only increased to 80% with severe exercise. Therefore the increased oxygen required during exercise has to be obtained from an increase in myocardial blood flow (MBF) 2. In circumstances of cardiac disease — especially (and in the West, most commonly) — coronary artery disease (CAD), the limits of adaptation are much more closely confined. Critical stenosis of an epicardial artery, whether such a stenosis is static or dynamic, sharply reduces coronary vasodilator reserve (CVR, the ratio of maximal MBF/resting MBF) in the myocardial territory supplied by the stenosed vessel3. (With respect to vulnerability to reduction in perfusion or to increase in demand, it is well established that the subendocardium is at greater risk than the subepicardium; this issue has been reviewed in extenso by Hoffman 4 and will not be discussed further here). MBF and therefore oxygen supply cannot increase adequately to satisfy the increased myocardial demand and aerobic metabolism can no longer be sustained downstream. Regional contractile function is compromised.

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Authors
  1. Stuart D. Rosen
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Editor information

Editors and Affiliations

  1. Department of Cardiology, Leiden University Medical Center Leiden, Leiden, The Netherlands

    Ernst E. Van Der Wall

  2. Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands

    Paul K. Blanksma  & Harry J. G. M. Crijns  & 

  3. Department of Cardiology, Martini Hospital, Groningen, The Netherlands

    Menco G. Niemeyer

  4. PET-center, University Hospital Groningen, Groningen, The Netherlands

    Willem Vaalburg

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Rosen, S.D. (1998). Functional Neuroimaging of Angina Pectoris. In: Van Der Wall, E.E., Blanksma, P.K., Niemeyer, M.G., Vaalburg, W., Crijns, H.J.G.M. (eds) Advanced Imaging In Coronary Artery Disease. Developments in Cardiovascular Medicine, vol 202. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0866-2_9

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  • DOI: https://doi.org/10.1007/978-94-007-0866-2_9

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3746-4

  • Online ISBN: 978-94-007-0866-2

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