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Abstract
Resting coronary flow and regional distribution are not affected by narrowing of up
to 85 percent of arterial diameter and therefore provide little insight into the effects
of stenoses on coronary hemodynamics. However, maximal coronary flow and coronary
flow reserve are markedly reduced by constrictions that do not affect resting flow.
Accordingly, coronary flow reserve and its relations to pressure-flow-resis-tance
characteristics of 177 single (10 dogs) and 125 double coronary stenoses in series
(7 dogs) were studied in open chest preparations. Coronary flow, aortic pressure and
left circumflex coronary pressure distal to a single or to each of two separate adjustable
coronary constrictors in series were simultaneously recorded while flow was varied
from basal to maximum by intracoronary injections of contrast medium.
The hyperemic response to contrast medium is a quantitative measure of coronary flow
reserve which was closely related to, and predictive of, the following characteristics
of single and double stenoses in series: (1) total pressure gradient and distal circumflex
perfusion pressure at resting coronary flow; (2) total pressure gradient and distal
circumflex pressure at hyperemic flow when effects of stenoses are greatest; and (3)
coronary stenoses resistance. Thus, the hyperemic response after injection of contrast
medium, or coronary flow reserve, is in itself a quantitative measure of the pressure-flow-resistance
characteristics of coronary constrictions. In addition, resistances of coronary stenoses
in series are shown to be additive; the flow effects of stenoses in series are not
generally determined by the dominant or most severe lesion, contrary to common clinical
precepts. These concepts are applicable to patients in assessing the effects of stenoses
on coronary hemodynamics.
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References
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Article info
Publication history
Accepted:
January 3,
1974
Identification
Copyright
© 1974 Published by Elsevier Inc.
