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on June 23, 2003

Circulation. 2003
Published online before print June 23, 2003, doi: 10.1161/01.CIR.0000080700.98607.D1
A more recent version of this article appeared on July 1, 2003
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Submitted on March 6, 2003
Revised on May 9, 2003
Accepted on May 12, 2003

Novel Index for Invasively Assessing the Coronary Microcirculation

William F. Fearon MD*, Leora B. Balsam MD, H. M. Omar Farouque MB, BS, PhD, Robert C. Robbins MD, Peter J. Fitzgerald MD, PhD, Paul G. Yock MD, and Alan C. Yeung MD

From the Divisions of Cardiovascular Medicine (W.F.F., O.F., P.J.F., P.G.Y., A.C.Y.) and Cardiothoracic Surgery (L.B.B., R.C.R.), Stanford University Medical Center, Stanford, Calif.

* To whom correspondence should be addressed. E-mail: wfearon{at}stanford.edu.

Background--A relatively simple, invasive method for quantitatively assessing the status of the coronary microcirculation independent of the epicardial artery is lacking.

Methods and Results--By using a coronary pressure wire and modified software, it is possible to calculate the mean transit time of room-temperature saline injected down a coronary artery. The inverse of the hyperemic mean transit time has been shown to correlate with absolute flow. We hypothesize that distal coronary pressure divided by the inverse of the hyperemic mean transit time provides an index of microcirculatory resistance (IMR) that will correlate with true microcirculatory resistance (TMR), defined as the distal left anterior descending (LAD) pressure divided by hyperemic flow, measured with an external ultrasonic flow probe. A total of 61 measurements were made in 9 Yorkshire swine at baseline and after disruption of the coronary microcirculation, both with and without an epicardial LAD stenosis. The mean IMR (16.9±6.5 U to 25.9±14.4 U, P=0.002) and TMR (0.51±0.14 to 0.79±0.32 mm Hg · mL-1 · min-1, P=0.0001), as well as the % change in IMR (147±66%) and TMR (159±105%, P=NS versus IMR % change), increased significantly and to a similar degree after disruption of the microcirculation. These changes were independent of the status of the epicardial artery. There was a significant correlation between mean IMR and TMR values, as well as between the % change in IMR and % change in TMR.

Conclusion--Measuring IMR may provide a simple, quantitative, invasive assessment of the coronary microcirculation.
Key words: microcirculation • coronary disease • pressure




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