Elsevier

American Heart Journal

Volume 118, Issue 2, August 1989, Pages 234-247
American Heart Journal

The function of the aorta in ischemic heart disease: A magnetic resonance and angiographic study of aortic compliance and blood flow patterns

https://doi.org/10.1016/0002-8703(89)90181-6Get rights and content

Abstract

Regional compliance of the ascending aorta, aortic arch, and the descending aorta was measured in 70 normal subjects at varying ages, in 17 patients with coronary artery disease (10 coronary artery disease patients, 3 with syndrome X), and in 13 trained athletes using magnetic resonance imaging. Ascending aortic compliance was measured angiographically in 22 patients with documented coronary artery disease and in 11 patients with syndrome X. Magnetic resonance velocity mapping was used in six patients with documented coronary artery disease and in three patients with syndrome X to study two-dimensional velocity profiles in the proximal and mid-ascending aorta and to quantify both forward and reverse flow. The measurements were compared with earlier published measurements from 24 normal subjects. It was found that patients with ischemic heart disease or syndrome X had decreased or no measurable aortic compliance and that they had significantly reduced or abnormal ascending aortic reverse flow likely to cause reduced coronary artery flow. A new theory is advanced that decreased myocardial perfusion leading to ischemic heart disease had two sources: (1) insufficient blood flow into the coronary artery inlet due to abnormal aortic function and independent of coronary artery stenosis and (2) local coronary artery stenosis. Observations supporting the theory are presented.

References (71)

  • KL Gould

    Percent coronary stenosis: battered gold standard, pernicious relic or clinical practicality?

    J Am Coll Cardiol

    (1988)
  • FJ Klocke

    Measurements of coronary blood flow and degree of stenosis: current clinical implications and continuing uncertainties

    J Am Coll Cardiol

    (1983)
  • JM Hodgson et al.

    Superiority of intracoronary papaverine to radiographic contrast for measuring coronary flow reserve in patients with ischemic heart disease

    Am Heart J

    (1987)
  • F Zijlstra et al.

    Which cineangiographically assessed anatomic variable correlates best with functional measurements of stenosis severity? A comparison of quantitative analysis of the coronary cineangiogram with measured coronary flow reserve and exercise/redistribution thallium-201 scintigraphy

    J Am Coll Cardiol

    (1988)
  • R Raymond et al.

    Myocardial infarction and normal coronary arteriography: A 10-year clinical and risk analysis of 74 patients

    J Am Coll Cardiol

    (1988)
  • RO Cannon et al.

    Angina caused by reduced vasodilator reserve of the small coronary arteries

    J Am Coll Cardiol

    (1983)
  • SE Epstein et al.

    Site of increased resistance to coronary flow in patients with angina pectoris and normal epicardial arteries

    J Am Coll Cardiol

    (1986)
  • RO Cannon

    Causes of chest pain in patients with normal coronary angiograms: the eye of the beholder

    Am J Cardiol

    (1988)
  • RO Cannon et al.

    “Microvascular angina” as a cause of chest pain with angiographically normal coronary arteries

    Am J Cardiol

    (1988)
  • M Yamagishi et al.

    Assessment of coronary blood flow by transesophageal two-dimensional pulsed Doppler echocardiography

    Am J Cardiol

    (1988)
  • DA Eggen et al.

    Variation of atherosclerosis with age

    Lab Invest

    (1968)
  • DS Freedman et al.

    Black-white differences in aortic fatty streaks in adolescence and early adulthood: the Bogalusa Heart Study

    Circulation

    (1988)
  • RH Mohiaddin et al.

    Regional aortic compliance studied by magnetic resonance imaging: the effects of age, training, and coronary artery disease

    Br Heart J

    (Summer 1989)
  • RH Klipstein et al.

    Blood flow patterns in the human aorta studied by magnetic resonance

    Br Heart J

    (1987)
  • SR Underwood et al.

    Magnetic resonance velocity mapping: clinical application of a new technique

    Br Heart J

    (1987)
  • GL Nayler et al.

    Blood flow imaging by cine magnetic resonance

    J Comput Assist Tomogr

    (1986)
  • DB Longmore
  • J Ross

    The coronary circulation

  • KI Neuhaus et al.

    Videodensitometric measurement of coronary flow

  • P Spiller et al.

    Measurement of systolic and diastolic flow rates in the coronary artery system by x-ray densitometry

    Circulation

    (1983)
  • EO Feigl

    Coronary physiology

    Physiol Rev

    (1983)
  • Bogren HG, Klipstein RH, Mohiaddin RH, Firmin DN, Underwood SR, O Rees RS. Pulmonary artery distensibility and blood...
  • CG Caro et al.

    The effect of haemodynamic factors on the arterial wall

  • WD Middleton et al.

    Flow reversal in the normal carotid bifurcation: color Doppler flow imaging analysis

    Radiology

    (1988)
  • BJ Bellhouse et al.

    Fluid mechanics of the aortic root with application to coronary flow

    Nature

    (1968)
  • Cited by (0)

    Dr. Bogren is on sabbatical leave from the Department of Radiology, University of California Davis, to National Heart and Chest Hospitals, London. Dr. Bogren is the recipient of a Fogarty Senior International Fellowship during part of this study.

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