European Heart Journal Advance Access originally published online on December 8, 2007
European Heart Journal 2008 29(1):120-127; doi:10.1093/eurheartj/ehm567
Right coronary artery flow impairment in patients with pulmonary hypertension
1 Department of Pulmonary Diseases, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands
2 Department of Physics and Medical Technology, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands
3 Department of Physiology, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands
4 Department of Clinical Epidemiology and Biostatistics, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands
5 Department of Cardiology, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands
6 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Received 26 July 2007; revised 31 October 2007; accepted 12 November 2007; online publish-ahead-of-print 8 December 2007.
* Corresponding author. Tel: +31 20 4444728, Fax: +31 20 4444382. Email: a.vonk{at}Vumc.nl
Aims: This study investigates whether increased right ventricular (RV) pressure in pulmonary hypertension (PH) impairs right coronary artery (RCA) flow and RV perfusion.
Methods: In 25 subjects, five patients with idiopathic pulmonary arterial hypertension, nine patients with chronic thromboembolic pulmonary arterial hypertension, and 11 healthy controls, flow of the RCA and left anterior descending (LAD) artery was measured with MR flow quantification.
Results: In PH, RCA peak systolic and mean systolic flow were lower, 1.02 ± 0.62 mL/s and 0.42 ± 0.30 mL/s, than peak and mean diastolic flow, 2.99 ± 1.97 mL/s (P < 0.001) and 1.73 ± 0.97 mL/s (P < 0.001); a pattern similar to the LAD. In contrast, in controls, RCA peak and mean flow in systole, 1.63 ± 0.58 mL/s and 0.72 ± 0.23 mL/s, were comparable to peak and mean flow in diastole, 1.72 ± 0.48 mL/s and 0.93 ± 0.28 mL/s (NS).
The systolic-to-diastolic flow ratio in the RCA, and mean flow per gram RV tissue, were inversely related to RV mass, R = –0.61 (P = 0.009), and R = –0.73 (P < 0.001) and to RV pressure, R = –0.83 (P < 0.001), and R = –0.57 (P = 0.033).
Conclusion: Although in controls, RCA flow is similar in systole and diastole, in PH there is systolic flow impediment, which is proportional to RV pressure and mass. In patients with severe RV hypertrophy total mean flow is reduced.
Key Words: Coronary artery flow • Pulmonary hypertension • Right ventricle • Magnetic resonance imaging • Chronic thromboembolic pulmonary hypertension
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