Maximal Myocardial Perfusion as a Measure of the Functional Significance of Coronary Artery Disease

From a Pathoanatomic to a Pathophysiologic Interpretation of the Coronary Arteriogram

AvN.H. Pijls

Inbunden, Engelska, 1991

Del i serien Developments in Cardiovascular Medicine

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Beskrivning

Coronary flow reserve is a functional measure of stenosis severity re flecting the integrated effects of its geometry including percent stenosis, absolute lumen area, length and shape. Its clinical application has been primarily qualitative in non-invasive, perfusion imaging. Measurement of coronary flow reserve during routine coronary arte riography has been an elusive goal. Transit time and indicator dilution techniques for assessing coronary flow reserve at cardiac catheteriza tion are associated with marked variability compared to microspheres or flow meters, thereby making their use questionable in comparison to the precision of good quantitative arteriography. Coronary flow reserve measured by special Doppler catheters as an adjunct to coronary arte riography shows in man the value of this integrated functional measure of stenosis severity and the limitations of percent diameter narrowing as a measure of its physiologic significance. However, Doppler catheters require additional instrumentation that is not yet an integral part of coronary arteriography and provide measures of absolute coronary flow reserve only. Relative maximum flow or relative flow reserve has been demon strated to be an important independent, complimentary descriptor of stenosis severity independent of fluctuating hemodynamic conditions. The method developed for DSA by Nico Pijls, described in this book is the first approach for assessing relative coronary flow reserve as a part of routine coronary arteriography by DSA. The theory and basic con cepts are well developed, experimental validation thorough and clinical applications timely.

Produktinformation

Utgivningsdatum:1991-10-31
Mått:155 x 235 x 13 mm
Vikt:471 g
Format:Inbunden
Språk:Engelska
Serie:Developments in Cardiovascular Medicine
Antal sidor:186
Upplaga:1991
Förlag:Kluwer Academic Publishers
ISBN:9780792314301

Utforska kategorier

Hjärt- och kärlsjukdomar inom Medicin

Recensioner i media

' Have I read a book on Coronary artery pathophysiology that is as clear and ass informative as this. ' International Journal of Cardiology 37 1992

Innehållsförteckning

1 Introduction.- 1.1 The limited value of classical coronary arteriography to predict the physiologic significance of coronary artery stenoses.- 1.2 Coronary flow reserve.- 1.3 Maximal coronary and myocardial blood flow.- 2 Methods of Measuring Myocardial Blood Flow.- 2.1 Laboratory methods.- 2.2 Clinical methods.- 3 Application of Indicator Dilution Theory in the Investigation of the Cardiovascular System.- 3.1 History.- 3.2 The two approaches in indicator dilution theory.- 3.3 Videodensitometry and digital arteriography for flow assessment in the coronary circulation.- 4 Problems and Limitations in the Application of Videodensitometry to Assess Coronary Blood Flow and Myocardial Perfusion.- 4.1 Influence of the contrast agent on flow.- 4.2 Changes in vascular volume.- 4.3 Contrast density vs contrast concentration.- 4.4 Difficulties in determination of mean transit time due to motion and insufficient image quality.- 4.5 Prerequisites for myocardial flow assessment by videodensitometry, according to the physiology of indicator dilution theory.- 5 A Model Study to Validate Calculation of Myocardial Blood Flow by Videodensitometry.- 5.1 Introduction.- 5.2 Materials and methods.- 5.3 Results.- 5.4 Discussion.- 5.5 Conclusions.- 6 Mean Transit Time for the Assessment of Myocardial Perfusion by Videodensitometry.- 6.1 Introduction.- 6.2 Methods.- 6.3 Results.- 6.4 Discussion.- 6.5 Clinical implications and limitations.- 7 The Concept of Maximal Flow Ratio for Immediate Evaluation of PTCA Result.- 7.1 Introduction.- 7.2 Methods.- 7.3 Results.- 7.4 Discussion.- 7.5 Limitations.- 8 Reproducibility of Mean Transit Time for Maximal Myocardial Flow Assessment.- 8.1 Introduction.- 8.2 Methods.- 8.3 Results.- 8.4 Discussion.- 9 General Discussion.- 9.1 Discussion.- 9.2 Conclusions.- 9.3 Limitations.- 9.4 Spin-off and Present Applications.- A Is Nonionic Isotonic Iohexol the Contrast Agent of Choice for Quantitative Myocardial Videodensitometry?.- A.1 Introduction.- A.2 Methods.- A.3 Results.- A.4 Discussion.- A.5 Conclusion.- B Fitting Procedures for Time-Density Curves.- Summary.