Alterazione globale nella regolazione del flusso coronarico regionale in pazienti con coronaropatia monovascolare evidenziata mediante tomografia ad emissione di positroni

AIM OF THE STUDY: Aim of this study is to investigate whether, in patients with coronary artery disease (CAD), regional myocardial blood flow (rMBF) regulation is affected with further mechanisms besides the effects of epicardial coronary stenosis. MATERIAL AND METHODS: RMBF and coronary reserve are measured in 13 normal subjects and in 36 patients with effort angina and isolated (> or = 50% diameter narrowing) left anterior descending (LAD, 27 patients) or left circumflex (LCX, 9 patients) coronary artery stenosis. Measurements are obtained both at baseline and following dipyridamole (0.56 mg/kg in 4 minutes) using positron emission tomography and N13-ammonia. RESULTS: At rest, patients with CAD show similar rMBF values in the stenotic and remote areas (0.71 +/- 0.19 vs 0.77 +/- 0.22 ml/min/gr, respectively, ns); both values are significantly (p < 0.01) reduced with respect to mean rMBF observed in the normal subjects (1.07 +/- 0.21 ml/min/gr). Following dipyridamole, patients with CAD show lower rMBF values in stenotic than in control regions (1.25 +/- 0.54 vs 1.73 +/- 0.80 ml/min/gr, p < 0.01); however, both these values are significantly reduced when compared with mean rMBF in the normal subjects (3.76 +/- 0.88 ml/min/gr, p < 0.01). To evaluate whether reduction in resting myocardial perfusion indicates maximal vasodilatation, patients with CAD are divided into 2 groups: Group 1 with homogeneous baseline perfusion (0.73 +/- 0.2 vs 0.75 +/- 0.24 ml/min/gr, in stenotic and remote areas, respectively, ns), and Group 2 with baseline perfusion defect in the stenotic related territory (0.62 +/- 0.14 vs 0.84 +/- 0.17 ml/min/gr, p < 0.01). Coronary reserve (dipyridamole flow/baseline flow) is similar in the 2 Groups (1.74 +/- 0.66 vs 1.93 +/- 0.45, ns). CONCLUSIONS: These data suggest that, in patients with CAD, other factors beyond hydraulic effects of epicardial coronary stenosis, could modulate rMBF regulation; in fact: 1) myocardium perfused by angiographically normal coronary artery shows reduced values of both resting rMBF and coronary reserve; 2) myocardium supplied by stenotic vessel maintains a residual vasodilating capability despite a reduced baseline perfusion.