Journal article
Comparison of three methods of evaluating coronary obstructive lesions: postmortem arteriography, pathologic examination and measurement of regional myocardium perfusion during maximal vasodilation
The American journal of cardiology, Vol.49(7), pp.1699-1706
05/1982
DOI: 10.1016/0002-9149(82)90248-x
PMID: 7081055
Abstract
Numerous studies of coronary obstructive lesions in patients by angiographic and pathologic techniques have concluded that the severity of obstruction is seriously underestimated by angiography. It has generally been assumed that morphologic examination of an undistended coronary vessel is a reasonable reference standard. To test this assumption, three methods of examining coronary arteries were compared in cynomolgus monkeys with diet-induced coronary atherosclerosis. Total and regional myocardial perfusion during maximal coronary vasodilation were measured, postmortem coronary arteriography was performed with contrast medium injected at systemic pressure and the undistended coronary vessels were extended pathologically. In these atherosclerotic monkeys, there were widespread intimai changes in the epicardial arteries ranging from fatty streaks to large plaques with medial atrophy; morphometric studies showed a mean (± standard error of the mean) luminal stenosis of 57 ± 3 percent (range 38 to 76). Postmortem coronary arteriograms showed no evidence of localized obstruction. Under resting conditions, global and transmural left ventricular perfusion were normal. During maximal coronary vasodilation, minimal coronary vascular resistance was higher (p <0.07) in these monkeys with atherosclerosis than in normal control monkeys (0.21 ± 0.04 versus 0.13 ± 0.07 mm Hg/ml × ml/min × 100 g). No evidence of localized perfusion deficits was observed in either group of monkeys under control conditions or during maximal coronary vasodilation.
The findings of unobstructed coronary angiograms and only modest impairment of perfusion, despite moderate obstructive lesions, suggest that at normal distending pressures coronary atherosclerotic lesions are outwardly displaced; medial atrophy may allow dilation and preservation of luminal size. Thus, in cynomolgus monkeys with diet-induced coronary atherosclerosis, pathologic examination of the undistended coronary vessel appears to overestimate the hemodynamic significance of the lesions. The relevance of these experimental findings to the evaluation of atherosclerotic coronary lesions in patients remains to be determined.
Details
- Title: Subtitle
- Comparison of three methods of evaluating coronary obstructive lesions: postmortem arteriography, pathologic examination and measurement of regional myocardium perfusion during maximal vasodilation
- Creators
- M L MarcusM L ArmstrongD D HeistadC L EasthamA L Mark
- Resource Type
- Journal article
- Publication Details
- The American journal of cardiology, Vol.49(7), pp.1699-1706
- Publisher
- United States
- DOI
- 10.1016/0002-9149(82)90248-x
- PMID
- 7081055
- ISSN
- 0002-9149
- eISSN
- 1879-1913
- Grant note
- HL 14230 / NHLBI NIH HHS HL 14388 / NHLBI NIH HHS HL00328 / NHLBI NIH HHS
- Language
- English
- Date published
- 05/1982
- Academic Unit
- Cardiovascular Medicine; Neuroscience and Pharmacology; Internal Medicine
- Record Identifier
- 9984040323302771
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