(Circulation. 2001;103:1109.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Peripheral Flow Response to Transient Arterial Forearm Occlusion Does Not Reflect Myocardial Perfusion Reserve
From the Departments of Cardiology B (M.B., M.M.M., I.D., T.T.N., K.S.) and A (J.R.), Aarhus University Hospital, and the Department of Pharmacology (N.H.B.), University of Aarhus, Aarhus, Denmark.
Correspondence to Morten Bøttcher, MD, Department of Cardiology B, Aarhus University Hospital (SKS), DK-8200 Aarhus N, Denmark. E-mail mboe{at}dadlnet.dk
Background—Ultrasonographic evaluation of systemic arterial function is widely available, and a close relation of endothelial function in the coronary and brachial arteries has been documented. It is unknown, however, whether a similar correlation exists for their 2 microcirculatory territories and thus whether assessment of the systemic microcirculation can be used similarly as a surrogate marker of myocardial perfusion.
Methods and Results—Twenty-three patients with documented coronary artery disease (CAD; 66±9 years old, 18 men), 16 patients with syndrome X (SX; 56±5 years old, 13 women), and 45 healthy control subjects (C; 34±9 years old, 22 men) were studied. Myocardial perfusion was measured at rest and after dipyridamole (0.56 mg · kg-1 · min-1 over 4 minutes) by PET, and brachial artery blood flow was measured at rest and after transient forearm ischemia by standard Doppler ultrasound techniques. Dipyridamole increased myocardial perfusion in all groups (mL · g-1 · min-1: CAD, 0.89±0.27 versus 1.62±0.67, P<0.001; SX, 0.82±0.16 versus 1.67±0.49, P<0.001; and C, 0.82±0.15 versus 2.32±0.64, P<0.001). Postocclusion forearm flow increased similarly in all groups (CAD, 52±18 versus 174±77 mL/min, P<0.001; SX, 49±29 versus 202±82 mL/min, P<0.001; and C, 61±34 versus 229±108 mL/min, P<0.001). No significant correlations were found between peripheral and myocardial microcirculatory beds for either resting flow, hyperemic flow, or flow reserve in any of the groups (r2<0.1, P=NS).
Conclusions—The peripheral perfusion responses to transient forearm ischemia do not correlate with dipyridamole-induced myocardial hyperemia. The lack of correlation indicates different mechanisms of microvascular activation or regulation and confirms that extrapolations between findings in the 2 vascular beds are not suitable.
Key Words: ultrasonics • microcirculation • perfusion • vasodilation • blood flow
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