Abnormal Epicardial Coronary Resistance in Patients With Diffuse Atherosclerosis but “Normal” Coronary Angiography

DOI Web Site 16 Citations
  • Bernard De Bruyne
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.
  • Ferry Hersbach
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.
  • Nico H.J. Pijls
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.
  • Jozef Bartunek
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.
  • Jan-Willem Bech
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.
  • Guy R. Heyndrickx
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.
  • K. Lance Gould
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.
  • William Wijns
    From the Cardiovascular Center Aalst (B.D.B., J.B., G.R.H., W.W.), Aalst, Belgium; the Catharina Hospital (F.H., J.W.B., N.H.J.P.), Eindhoven, the Netherlands; and the University of Texas Medical School (K.L.G.), Houston.

Description

<jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Background</jats:italic> </jats:bold> </jats:italic> </jats:bold> Coronary arteries without focal stenosis at angiography are generally considered non–flow-limiting. However, atherosclerosis is a diffuse process that often remains invisible at angiography. Accordingly, we hypothesized that in patients with coronary artery disease, nonstenotic coronary arteries induce a decrease in pressure along their length due to diffuse coronary atherosclerosis. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Methods and Results</jats:italic> </jats:bold> </jats:italic> </jats:bold> Coronary pressure and fractional flow reserve (FFR), as indices of coronary conductance, were obtained from 37 arteries in 10 individuals without atherosclerosis (group I) and from 106 nonstenotic arteries in 62 patients with arteriographic stenoses in another coronary artery (group II). In group I, the pressure gradient between aorta and distal coronary artery was minimal at rest (1±1 mm Hg) and during maximal hyperemia (3±3 mm Hg). Corresponding values were significantly larger in group II (5±4 mm Hg and 10±8 mm Hg, respectively; both <jats:italic>P</jats:italic> <0.001). The FFR was near unity (0.97±0.02; range, 0.92 to 1) in group I, indicating no resistance to flow in truly normal coronary arteries, but it was significantly lower (0.89±0.08; range, 0.69 to 1) in group II, indicating a higher resistance to flow. In 57% of arteries in group II, FFR was lower than the lowest value in group I. In 8% of arteries in group II, FFR was <0.75, the threshold for inducible ischemia. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Conclusion</jats:italic> </jats:bold> </jats:italic> </jats:bold> Diffuse coronary atherosclerosis without focal stenosis at angiography causes a graded, continuous pressure fall along arterial length. This resistance to flow contributes to myocardial ischemia and has consequences for decision-making during percutaneous coronary interventions. </jats:p>

Journal

  • Circulation

    Circulation 104 (20), 2401-2406, 2001-11-13

    Ovid Technologies (Wolters Kluwer Health)

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