Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Mol Cell Cardiol. 2012 Apr;52(4):786-93. doi: 10.1016/j.yjmcc.2011.07.025. Epub 2011 Aug 10.
Recent technological advancements in the area of intracoronary physiology, as well as non-invasive contrast perfusion imaging, allow to make clinical decisions with respect to percutaneous coronary interventions and to identify microcirculatory coronary pathophysiology. The basic characteristics of coronary hemodynamics, as described by pressure-flow relations in the normal and diseased heart, need to be understood for a proper interpretation of these physiological measurements. Especially the hyperemic coronary pressure-flow relation, as well as the influence of cardiac function on it, bears great clinical significance. The interaction of a coronary stenosis with the coronary pressure-flow relation can be understood from the stenosis pressure drop-flow velocity relationship. Based on these relationships the clinically applied concepts of coronary flow velocity reserve, fractional flow reserve, stenosis resistance and microvascular resistance are discussed. Attention is further paid to the heterogeneous nature of myocardial perfusion, the vulnerability of the subendocardium and the role of collateral flow on hyperemic coronary pressure-flow relations. This article is part of a Special Issue entitled "Coronary Blood Flow".
近年来，冠状动脉生理学领域以及非侵入性对比灌注成像技术的进步，使得我们能够针对经皮冠状动脉介入治疗做出临床决策，并识别微血管冠状动脉病理生理学。为了正确解释这些生理测量结果，需要了解正常和患病心脏的压力-流量关系所描述的冠状动脉血液动力学的基本特征。特别是，充血状态下的冠状动脉压力-流量关系及其对心功能的影响具有重要的临床意义。冠状动脉狭窄与冠状动脉压力-流量关系的相互作用可以从狭窄压力降-流速关系来理解。基于这些关系，本文讨论了临床上应用的冠状动脉血流储备、血流储备分数、狭窄阻力和微血管阻力等概念。此外，本文还关注了心肌灌注的异质性、心内膜下心肌的脆弱性以及侧支血流对充血状态下冠状动脉压力-流量关系的影响。本文是题为“冠状动脉血流”的特刊的一部分。
