HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: 285/5/H2194    most recent 01021.2002v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (20) Citing Articles via Google Scholar Google Scholar Articles by Chamuleau, S. A. J. Articles by Piek, J. J. Search for Related Content PubMed PubMed Citation Articles by Chamuleau, S. A. J. Articles by Piek, J. J.

Association between coronary lesion severity and distal microvascular resistance in patients with coronary artery disease

¹Department of Cardiology and ²Department of Medical Physics, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands

Submitted 10 December 2002 ; accepted in final form 18 June 2003

Homogeneity of microvascular resistance in different perfusion areas of the same heart is generally assumed. We investigated the effect of the severity of an epicardial stenosis on microvascular resistance in 27 patients with coronary artery disease and stable angina. All patients had an angiographically normal coronary artery, an artery with an intermediate lesion, and an artery with a severe lesion; the latter was treated with angioplasty. In each patient, distal blood flow velocity and pressure were measured during baseline and maximal hyperemia (induced by intracoronary adenosine) using a Doppler and pressure guide wire, respectively. The ratio of mean distal pressure to average peak blood flow velocity was used as an index for the microvascular resistance (MR_v). Within patients, the hyperemic MR_v was higher in arteries with more severe stenosis (P = 0.021). After percutaneous transluminal coronary angioplasty (PTCA), the hyperemic MR_v decreased (pre-PTCA, 2.6 vs. post-PTCA, 1.9 mmHg·cm^–1s^–1, P < 0.01) toward the value of the reference artery (1.7 mmHg·cm^–1s^–1; P = 0.67). We conclude that there is a positive association between coronary lesion severity and variability of distal microvascular resistance that normalizes after angioplasty. This study challenges the concept of uniform distribution of hyperemic MR_v that is relevant for the interpretation of both noninvasive and invasive diagnostic tests.

microcirculation; coronary disease; physiology; blood flow; blood pressure

This article has been cited by other articles:

				O. Sorop, D. Merkus, V. J. de Beer, B. Houweling, A. Pistea, E. O. McFalls, F. Boomsma, H. M. van Beusekom, W. J. van der Giessen, E. VanBavel, et al. Functional and Structural Adaptations of Coronary Microvessels Distal to a Chronic Coronary Artery Stenosis Circ. Res., April 11, 2008; 102(7): 795 - 803. [Abstract] [Full Text] [PDF]

				K. M. Marques, P. Knaapen, R. Boellaard, N. Westerhof, A. A. Lammertsma, C. A. Visser, and F. C. Visser Hyperaemic microvascular resistance is not increased in viable myocardium after chronic myocardial infarction Eur. Heart J., October 1, 2007; 28(19): 2320 - 2325. [Abstract] [Full Text] [PDF]

				N. H. J. Pijls Fractional flow reserve after previous myocardial infarction Eur. Heart J., October 1, 2007; 28(19): 2301 - 2302. [Full Text] [PDF]

				J. J. Piek Beyond Epicardial Reperfusion N. Engl. J. Med., May 3, 2007; 356(18): 1880 - 1882. [Full Text] [PDF]

				M. J. Kern, A. Lerman, J.-W. Bech, B. De Bruyne, E. Eeckhout, W. F. Fearon, S. T. Higano, M. J. Lim, M. Meuwissen, J. J. Piek, et al. Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology Circulation, September 19, 2006; 114(12): 1321 - 1341. [Abstract] [Full Text] [PDF]

				M. K.C. Ng, A. C. Yeung, and W. F. Fearon Invasive Assessment of the Coronary Microcirculation: Superior Reproducibility and Less Hemodynamic Dependence of Index of Microcirculatory Resistance Compared With Coronary Flow Reserve Circulation, May 2, 2006; 113(17): 2054 - 2061. [Abstract] [Full Text] [PDF]

				B.-J. Verhoeff, M. Siebes, M. Meuwissen, B. Atasever, M. Voskuil, R. J. de Winter, K. T. Koch, J. G.P. Tijssen, J. A.E. Spaan, and J. J. Piek Influence of Percutaneous Coronary Intervention on Coronary Microvascular Resistance Index Circulation, January 4, 2005; 111(1): 76 - 82. [Abstract] [Full Text] [PDF]

				W. Aarnoudse, W. F. Fearon, G. Manoharan, M. Geven, F. van de Vosse, M. Rutten, B. De Bruyne, and N. H.J. Pijls Epicardial Stenosis Severity Does Not Affect Minimal Microcirculatory Resistance Circulation, October 12, 2004; 110(15): 2137 - 2142. [Abstract] [Full Text] [PDF]

				M. Siebes, B.-J. Verhoeff, M. Meuwissen, R. J. de Winter, J. A.E. Spaan, and J. J. Piek Single-Wire Pressure and Flow Velocity Measurement to Quantify Coronary Stenosis Hemodynamics and Effects of Percutaneous Interventions Circulation, February 17, 2004; 109(6): 756 - 762. [Abstract] [Full Text] [PDF]