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

Coronary interventions - Mini focus on coronary physiology

Normal values of thermodilution-derived absolute coronary blood flow and microvascular resistance in humans

EuroIntervention 2021;17:e309-e316. DOI: 10.4244/EIJ-D-20-00684

1. Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium; 2. Lausanne University Centre Hospital, Lausanne, Switzerland; 3. Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; 4. Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands; 5. Department of Biomedical Engineering Eindhoven University of Technology, Eindhoven, the Netherlands

Background: Absolute hyperaemic coronary blood flow (Q, in mL/min) and resistance (R, in Wood units [WU]) can be measured invasively by continuous thermodilution.

Aims: The aim of this study was to assess normal reference values of Q and R.

Methods: In 177 arteries (69 patients: 25 controls, i.e., without identifiable coronary atherosclerosis; 44 patients with mild, non-obstructive atherosclerosis), thermodilution-derived hyperaemic Q and total, epicardial, and microvascular absolute resistances (Rtot, Repi, and Rmicro) were measured. In 20 controls and 29 patients, measurements were obtained in all three major coronary arteries, thus allowing calculations of Q and R for the whole heart. In 15 controls (41 vessels) and 25 patients (71 vessels), vessel-specific myocardial mass was derived from coronary computed tomography angiography.

Results: Whole heart hyperaemic Q tended to be higher in controls compared to patients (668±185 vs 582±138 mL/min, p=0.068). In the left anterior descending coronary artery (LAD), hyperaemic Q was significantly higher (293±102 mL/min versus 228±71 mL/min, p=0.004) in controls than in patients. This was driven mainly by a difference in Repi (43±23 vs 83±41 WU, p=0.048), without significant differences in Rmicro. After adjustment for vessel-specific myocardial mass, hyperaemic Q was similar in the three vascular territories (5.9±1.9, 4.9±1.7, and 5.3±2.1 mL/min/g, p=0.44, in the LAD, left circumflex and right coronary artery, respectively).

Conclusions: The present report provides reference values of absolute coronary hyperaemic Q and R. Q was homogeneously distributed in the three major myocardial territories but the large ranges of observed hyperaemic values of flow and of microvascular resistance preclude their clinical use for inter-patient comparison.

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