Editorial

DOI: 10.4244/EIJ-E-24-00022

Epicardial inflow versus myocardial distribution: average regional transmural coronary flow is not enough

Nils P. Johnson1, MD, MS; K. Lance Gould1, MD

The collaborative paper from the multinational ILIAS Registry on hyperaemic stenosis resistance (HSR) by Boerhout et al in this issue of EuroIntervention1 provides the occasion to discuss a key distinction between flow in the epicardial coronary arteries versus its subsequent distribution across the layers of the myocardium. In short, measures of regional average transmural perfusion do not capture clinically essential information for managing many patients.

Inflow versus distribution

An important mechanistic paper from over 50 years ago offers insights regarding transmural flow distribution across the left ventricular (LV) wall2. In an animal model, the investigators studied simultaneous epicardial blood flow and its subendocardial versus subepicardial distribution. Across a range of perturbations, coronary flow increased or decreased relative to baseline. For each condition, the relative ratio of subendocardial to subepicardial blood flow was computed in tissue samples from the inner third to outer third circumferentially across the LV wall. Figure 1 plots data from Table 1 of their manuscript, demonstrating two major points.

First, when coronary blood flow decreases below baseline levels, subendocardial flow always decreases...

Sign in to read
the full article

Forgot your password?
No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 20 Number 11
Jun 3, 2024
Volume 20 Number 11
View full issue


Key metrics

Suggested by Cory

Original Research

10.4244/EIJ-D-23-00713 Jun 3, 2024
Impact of hyperaemic stenosis resistance on long-term outcomes of stable angina in the ILIAS Registry
Boerhout C et al

10.4244/EIJV9I1A26 May 21, 2013
Commentary on “Hybrid iFR-FFR decision-making strategy…” by Petraco et al
El-Omar M and Mamas MA
free

10.4244/EIJV17I4A46 Jul 20, 2021
Beyond ischaemia: is there a place for physiologic and anatomic evaluations of coronary lesions?
Montalescot G and Zeitouni M
free

10.4244/EIJV9I12A250 Apr 22, 2014
Coronary wedge pressure and collateral flow contribution: not a dichotomy!
van Lavieren M et al
free
Trending articles
69.746

10.4244/EIJV13I12A217 Dec 8, 2017
Swimming against the tide: insights from the ORBITA trial
Al-Lamee R and Francis D
free
58.8

State-of-the-Art

10.4244/EIJ-D-24-00066 Apr 21, 2025
Management of complications after valvular interventions
Bansal A et al
free
57.6

State-of-the-Art

10.4244/EIJ-D-24-00386 Feb 3, 2025
Mechanical circulatory support for complex, high-risk percutaneous coronary intervention
Ferro E et al
free
38.75

State-of-the-Art

10.4244/EIJ-D-23-00912 Oct 7, 2024
Optical coherence tomography to guide percutaneous coronary intervention
Almajid F et al
free
15.85

State-of-the-Art

10.4244/EIJ-D-23-01050 Jul 15, 2024
Durability of transcatheter aortic valve implantation
Ternacle J et al
free
11.8

EXPERIMENTAL RESEARCH

10.4244/EIJ-D-17-00595 Jan 19, 2018
Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation
Abdelghani M et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved