Effects of coronary revascularisation on myocardial blood flow and coronary vasodilator reserve in hibernating myocardium

Domenico Pagano, F Fath-Ordoubadi, K Beatt, Jonathan Townend, Robert Bonser, P Carrici

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

OBJECTIVE: Previous studies have suggested that resting myocardial blood flow is within normal limits in most chronically dysfunctional left ventricular segments which improve function after coronary artery revascularisation (hibernating myocardium). The aim of this study was to assess myocardial blood flow and coronary vasodilator reserve in hibernating myocardium before and after coronary revascularisation. PATIENTS AND METHODS: 30 patients with multivessel coronary disease undergoing coronary revascularisation (21 patients with bypass grafting and nine with coronary angioplasty), and 21 age and sex matched healthy volunteers (controls). Myocardial blood flow (MBF, ml/min/g) was measured by positron emission tomography using oxygen-15 water at rest and after dipyridamole (MBFdip, 0.56 mg/kg in four minutes). Coronary vasodilator reserve was calculated as MBFdip/MBF. Regional wall motion was assessed with echocardiography. RESULTS: Before revascularisation there were 48 remote and 275 dysfunctional myocardial segments, of which 163 (59%) improved function after revascularisation (hibernating). In hibernating segments coronary vasodilator reserve before revascularisation was significantly lower than in remote segments (1.97 (0.7), p <0.0001) and controls (3.2 (1.5), p <0.0001). In hibernating segments, myocardial blood flow remained unchanged after revascularisation (0.94 (0.3) v 0.95 (0.3) ml/min/g, p = 0.3) while coronary vasodilator reserve increased (1. 47 (0.7) v 1.98 (1.0), p <0.0001). Myocardial blood flow was similar in remote, hibernating segments before and after revascularisation and in controls. CONCLUSIONS: This study confirms that myocardial blood flow at rest in hibernating myocardium is within normal limits in most segments, and that hibernating myocardium is characterised by an impaired coronary vasodilator reserve which improves significantly after coronary revascularisation.
Original languageEnglish
Pages (from-to)208-212
Number of pages5
JournalBritish Heart Journal
Volume85
Issue number2
DOIs
Publication statusPublished - 1 Feb 2001

Keywords

  • hibernating myocardium
  • myocardial blood flow
  • heart failure
  • positron emission tomography

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