Schühlen H, Eigler N L, Whiting J S
Department of Medicine and Research Institute, Cedars-Sinai Medical Center, Los Angeles.
Circulation. 1994 Mar;89(3):1004-12. doi: 10.1161/01.cir.89.3.1004.
Our study compares the effect of acute proximal stenosis of a coronary artery supplying a myocardial perfusion bed with that of stenosis of an adjacent artery resulting in collateral flow diversion supplied by the same perfusion bed. These alterations in coronary physiology were quantified by digital angiographic impulse response analysis of contrast material mean transit time for the coronary microcirculation, Tmicro, and by flowmeter and microsphere assessment of flow and regional flow distribution.
In 25 open-chest, anesthetized dogs, progressive circumflex artery stenosis led to a concordant decrease of circumflex artery resting and hyperemic flow, coronary flow reserve, and inverse angiographic mean transit time Tmicro-1 (P < .01). Progressive left anterior descending artery stenosis led to no or only minor changes of circumflex artery resting or hyperemic flow or flow reserve; only occlusion induced a significant decrease of coronary flow reserve (from 4.0 +/- 0.7 to 3.2 +/- 0.5, P < .05), whereas resting flow was increased by +8.6 +/- 5.9%. In contrast, circumflex artery Tmicro-1 diminished significantly with critical left anterior descending artery stenosis and occlusion (from 16.7 +/- 4.2 to 12.6 +/- 2.2 [P < .05] and 12.0 +/- 3.0 min-1 [P < .01], respectively). In 8 dogs, collateral flow induced by left anterior descending artery occlusion was quantified by microsphere injections. The decrease of circumflex artery Tmicro-1 correlated with the magnitude of collateral flow (r = .76) and was associated with the angiographic extent of collateral filling.
Digital angiographic impulse response analysis is a sensitive method to detect the influence of proximal artery stenosis on an artery's myocardial perfusion bed as well as the changes induced by an adjacent artery stenosis inducing collateral flow diversion from the supplying myocardial perfusion zone.
我们的研究比较了供应心肌灌注床的冠状动脉急性近端狭窄与相邻动脉狭窄导致同一灌注床侧支血流分流的影响。通过对冠状动脉微循环造影剂平均通过时间Tmicro进行数字血管造影脉冲响应分析，以及通过流量计和微球评估血流和区域血流分布，对这些冠状动脉生理变化进行了量化。
在25只开胸麻醉犬中，左旋支动脉逐渐狭窄导致左旋支动脉静息和充血血流、冠状动脉血流储备以及血管造影平均通过时间倒数Tmicro -1一致降低（P <.01）。左旋支动脉逐渐狭窄对左旋支动脉静息或充血血流或血流储备无影响或仅有轻微变化；只有闭塞导致冠状动脉血流储备显著降低（从4.0±0.7降至3.2±0.5，P <.05），而静息血流增加了+8.6±5.9%。相比之下，左旋支动脉Tmicro -1在左前降支动脉严重狭窄和闭塞时显著降低（分别从16.7±4.2降至12.6±2.2 [P <.05]和12.0±3.0 min-1 [P <.01]）。在8只犬中，通过微球注射对左前降支动脉闭塞诱导的侧支血流进行了量化。左旋支动脉Tmicro -1的降低与侧支血流大小相关（r =.76），并与侧支充盈的血管造影范围相关。
数字血管造影脉冲响应分析是一种敏感的方法，可检测近端动脉狭窄对动脉心肌灌注床的影响，以及相邻动脉狭窄诱导供应心肌灌注区侧支血流分流所引起的变化。
