Coronary Artery Flow Velocity Is Related To Lumen Area and Regional Left Ventricular Mass

Anderson, H V; Stokes, M. J.; Leon, Miltiadis N; Abu‐Halawa, Subhi; Stuart, Yvonne; Kirkeeide, Richard L.

doi:10.1161/01.cir.102.1.48

Cited by 99 publications

(50 citation statements)

References 40 publications

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“…As Anderson et al demonstrated, the CFV is inversely related to the lumen size that exists for the distal myocardial bed; the decrease in basal CFV indicated the dilation of the coronary artery. 6 We observed this phenomenon both in echocardiographic and angiographic results in the present study. The basal CFV significantly decreased after NTG administration.…”

Section: Discussionsupporting

confidence: 75%

“…12 However, the present study significantly demonstrated the inverse relationship between flow parameters and LD in the patients, as previously shown in the animal study. 6 As NTG has been thought to dilate the larger coronary vessels and mostly have an impact on the epicardial artery, 13 the NTG-induced decrease of the baseline CFV suggested the significant dilatation of the epicardial arteries. While the baseline CFV varied, hyperemic CFV was relatively constant among the circumstances, before and after NTG administration.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, it has been difficult to non-invasively assess the coronary arterial tone. 5 As the coronary flow velocity (CFV) is inversely related to the luminal size that exists for the distal myocardial bed, 6 the elevated basal arterial tone can be assessed as the higher flow velocity in the epicardial artery. Recently, the transthoracic Doppler echocardiography (TTDE) technique has emerged to take reliable measurements of the CFV and CFV reserve (CFVR) in the left anterior descending artery (LAD) using intravenous administration of adenosine 5'-triphosphate (ATP).…”

mentioning

confidence: 99%

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Non-Invasive Assessment of Coronary Arterial Tone Using Trans-Thoracic Doppler Echocardiography

Takagi

Tsurumi

Arai

et al. 2006

Circ J

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oronary arterial tone impacts the frequency and the threshold of angina attack in patients with coronary artery disease. 1,2 The basal coronary arterial tone is known to be increased in patients with coronary spastic angina (CSA). 3,4 The high arterial tone is associated with the hyper-sensitive response to the intracoronary injection of acetylcholine or ergonovine in patients with CSA. 4 However, it has been difficult to non-invasively assess the coronary arterial tone. 5 As the coronary flow velocity (CFV) is inversely related to the luminal size that exists for the distal myocardial bed, 6 the elevated basal arterial tone can be assessed as the higher flow velocity in the epicardial artery. Recently, the transthoracic Doppler echocardiography (TTDE) technique has emerged to take reliable measurements of the CFV and CFV reserve (CFVR) in the left anterior descending artery (LAD) using intravenous administration of adenosine 5'-triphosphate (ATP). 7-9 Accordingly, we evaluated the usefulness of TTDE for the non-invasive assessment of the coronary arterial tone in human LAD. Methods Study Patients and Study DesignWe studied 32 consecutive patients with chest pain at rest who underwent a coronary angiography and had no Circulation Journal Vol.70, April 2006 significant stenoses. Two patients were excluded because of the suboptimal measurements in TTDE. A total of 30 patients (age 40 to 77 years, mean 59.8±9.3 years old, 21 male, 9 female) were included for further analysis.The Institutional Review Board approved the study, and the patients provided written informed consent. Vasodilators were withdrawn at least 72 h before the study, except sublingual nitroglycerin (NTG), which was withdrawn at least 2 h before the study. The patients fasted overnight and did not smoke within 2 h prior to the study. All foods or drinks containing flavonoid or catechins were withheld during the study. The Doppler examinations were performed in the morning. The Doppler echocardiographic measurements were conducted before and 3 min after the oral administration of NTG. CFV MeasurementsTTDE was performed with a 5 MHz transducer connected to a Vivid 7 echocardiographic machine (GEVingmed Ultrasound, Horton, Norway), by an experienced investigator. The distal LAD was examined by using color Doppler mapping with a velocity range from -15 to +15 cm/s. After positioning a sample volume where the ultrasonic beam was as parallel to the direction of the distal LAD as possible, the spectral Doppler signal was recorded by fast Fourier transformation analysis for the baseline measurement. Thereafter, Doppler signals were obtained under the maximal hyperemic conditions during the intravenous infusion of ATP at the speed of 0.14 mg· kg -1 · min -1 . Images were stored on a 5-inch MO disk for offline analysis. The mean diastolic flow velocity was traced for the CFV measurements. The measurements were averaged over 3 cardiac cycles. The CFVR was calculated as the

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Non-Invasive Assessment of Coronary Arterial Tone Using Trans-Thoracic Doppler Echocardiography

Takagi

Tsurumi

Arai

et al. 2006

Circ J

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“…Therefore, mean coronary flow velocity is the same throughout the epicardial coronary system and thus the site where flow velocity is measured has no impact on the v-dp relation. 16 Some patients have aneurysmatic coronary arteries or a poststenotic dilatation. When flow was measured in a wide segment, flow velocities were lower and the v-dp relation became steeper, as demonstrated in figure 5.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the flow velocity-pressure gradient relation in the assessment of stenoses: an in vitro study

Marques¹,

Westerhof²

2008

NHJL

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Objectives. The flow velocity-pressure gradient (v-dp) relation is clinically used to assess coronary stenoses. This in vitro study aimed to investigate the ability to determine the impact of each individual stenosis in the setting of two consecutive stenoses, the effect of variable stenosis reference diameters and the impact of one or two wires in a stenosis, on the v-dp relation. Methods. The model consisted of a reservoir and different sized tubes and stenoses. Pressure gradient and flow velocity were assessed with a pressure and a Doppler wire. By plotting flow velocity and pressure gradient on an X-Y plot, the v-dp relation was determined. Results. The v-dp relation of a proximal stenosis was not influenced by a distal stenosis. The diameter of the segment where flow velocity was measured influenced the v-dp relation. This could be corrected by substituting flow velocity with volume flow. The presence of one or two wires in a stenosis made the v-dp relation substantially steeper. Conclusions. The v-dp relation can be used to determine the significance of each individual stenosis in arteries with consecutive stenoses, provided that the distance between the stenoses is large enough. The diameter of the segment where flow velocity is measured and the presence of one or two wires substantially affect the v-dp relation. (Neth Heart J 2008;16:156-62.)

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“…Myocardial perfusion must be adequate to cope with increased myocardial oxygen demand, 25 but ventricular hypertrophy may potentially impair coronary blood flow. 26 Coronary reserve represents the ability of the heart to increase myocardial blood flow under circumstances of increased demand. Since wall tension may be represented by ventricular wall stress, coronary reserve/stress was devised as a surrogate of coronary flow/demand imbalance.…”

Section: Discussionmentioning

confidence: 99%

The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension

Frimm¹,

Pereira²,

Rodrigues

et al. 2005

Clinical Cardiology

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SummaryBackground: The pathophysiologic role of coronary reserve impairment in hypertensive cardiac dysfunction is still debated. Previously, we demonstrated that satisfactory coronary vasodilatation may coexist with ventricular systolic dysfunction. It is conceivable that coronary reserve might otherwise be inappropriate for enhanced myocardial oxygen demand and may thus affect cardiac performance negatively.Hypothesis: Myocardial supply-demand imbalance contributes to the severity of ventricular dysfunction in hypertension (HTN).Methods: Fractional shortening (%) and end-systolic stress (10 3 ·dyn·cm Ϫ2 ) were determined using echocardiography, and coronary reserve was calculated using transesophageal Doppler echocardiography. Coronary reserve/ stress (cm 2 ·dyn Ϫ1 ) was utilized as a measure of supply-demand. Groups NL (20 healthy subjects), HTN1 (15 patients, fractional shortening ≥ 30), HTN2 (19 patients, 20 ≤ fractional shortening < 30), and HTN3 (21 patients, fractional shortening < 20) were constituted.Results: Compared with NL and HTN1, groups HTN2 and HTN3 had significantly (p < 0.05) greater end-systolic stress (NL = 72 ± 16, HTN1 = 72 ± 23, HTN2 = 143 ± 32, HTN3 = 186 ± 70). Coronary reserve was impaired in HTN3 alone (NL = 3.5 ± 0.6, HTN1 = 3.4 ± 1.0, HTN2 = 3.1 ± 1.0, HTN3 = 2.6 ± 1.1), but coronary reserve/stress was reduced in both

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Coronary Artery Flow Velocity Is Related To Lumen Area and Regional Left Ventricular Mass

Cited by 99 publications

References 40 publications

Non-Invasive Assessment of Coronary Arterial Tone Using Trans-Thoracic Doppler Echocardiography

Non-Invasive Assessment of Coronary Arterial Tone Using Trans-Thoracic Doppler Echocardiography

Characteristics of the flow velocity-pressure gradient relation in the assessment of stenoses: an in vitro study

The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension

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