Circulation, Vol 72, 82-92, Copyright © 1985 by American Heart Association
RF Wilson, DE Laughlin, PH Ackell, WM Chilian, MD Holida, CJ Hartley, ML Armstrong, ML Marcus and CW White
Assessment of coronary blood flow and the vasodilator reserve capacity of
individual coronary arteries in the catheterization laboratory has been
hampered by methodologic limitations. We have developed and validated a
small Doppler catheter that can subselectively measure phasic coronary
blood flow velocity (CBFV). In seven anesthetized calves, CBFV was varied
from 0.1 to 5.7 times control CBFV. Changes in mean CBFV measured
intraluminally by catheter in the left anterior descending and left
circumflex arteries were similar to those measured simultaneously with an
epicardial Doppler probe on the surface of the same vessel (n = 85, r =
.95, slope = 1.04) and to changes in coronary sinus flow (n = 69, r = .97,
slope = 1.06) measured with timed venous collections. Identical maximal
coronary reactive hyperemic responses with the catheter present and absent
in the artery being studied demonstrated that coronary obstruction by the
catheter was minimal. Safety studies in six additional calves demonstrated
that the catheter caused small changes in coronary endothelial
permeability. Histologic studies revealed no endothelial denudation or
thrombus formation. Stable phasic recordings of coronary blood flow
velocity have been obtained in 58 of 70 patients studied. One of the 70
patients studied had abrupt coronary occlusion probably related to
catheter-induced vasospasm. In 10 normal patients, intracoronary meglumine
diatrizoate increased CBFV to 3.5 times that at rest (range 2.8 to 5.0).
CBFV rose 5.0-fold after an intravenous infusion of dipyridamole (range 3.8
to 7.0). In each patient, dipyridamole produced greater vasodilation than
meglumine diatrizoate. The time- and dose-response characteristics to
dipyridamole infusion were heterogeneous, underscoring the advantage of
continuous on-line measurement of CBFV in the measurement of vasodilator
reserve. This method of measuring CBFV and assessing vasodilator reserve in
the catheterization laboratory should facilitate studies of the coronary
circulation in man.
ARTICLES
Transluminal, subselective measurement of coronary artery blood flow velocity and vasodilator reserve in man
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