Digital angiographic impulse response analysis of regional myocardial perfusion. Detection of autoregulatory changes in nonstenotic coronary arteries induced by collateral flow to adjacent stenotic arteries.

Abstract

BACKGROUND Our study compares the effect of acute proximal stenosis of a coronary artery supplying a myocardial perfusion bed with that of stenosis of an adjacent artery resulting in collateral flow diversion supplied by the same perfusion bed. These alterations in coronary physiology were quantified by digital angiographic impulse response analysis of contrast material mean transit time for the coronary microcirculation, Tmicro, and by flowmeter and microsphere assessment of flow and regional flow distribution. METHODS AND RESULTS In 25 open-chest, anesthetized dogs, progressive circumflex artery stenosis led to a concordant decrease of circumflex artery resting and hyperemic flow, coronary flow reserve, and inverse angiographic mean transit time Tmicro-1 (P < .01). Progressive left anterior descending artery stenosis led to no or only minor changes of circumflex artery resting or hyperemic flow or flow reserve; only occlusion induced a significant decrease of coronary flow reserve (from 4.0 +/- 0.7 to 3.2 +/- 0.5, P < .05), whereas resting flow was increased by +8.6 +/- 5.9%. In contrast, circumflex artery Tmicro-1 diminished significantly with critical left anterior descending artery stenosis and occlusion (from 16.7 +/- 4.2 to 12.6 +/- 2.2 [P < .05] and 12.0 +/- 3.0 min-1 [P < .01], respectively). In 8 dogs, collateral flow induced by left anterior descending artery occlusion was quantified by microsphere injections. The decrease of circumflex artery Tmicro-1 correlated with the magnitude of collateral flow (r = .76) and was associated with the angiographic extent of collateral filling. CONCLUSIONS Digital angiographic impulse response analysis is a sensitive method to detect the influence of proximal artery stenosis on an artery's myocardial perfusion bed as well as the changes induced by an adjacent artery stenosis inducing collateral flow diversion from the supplying myocardial perfusion zone.