VARIATIONS IN NORMAL CORONARY VASODILATORY RESERVE STRATIFIED BY ARTERY, GENDER, HEART-TRANSPLANTATION AND CORONARY-ARTERY DISEASE

Objectives. The purpose of the study was to assess the spectrum of cor onary vasodilatory reserve values in patients with angiographically no rmal arteries who had atypical chest pain syndromes or remote coronary artery disease or were heart transplant recipients. Background. The m easurement of post-stenotic coronary vasodilatory reserve, now possibl e in a large number of patients in the cardiac catheterization laborat ory, is increasingly used for decision making. Controversy exists rega rding the range of normal values obtained in angiographically normal c oronary arteries in patients with different clinical presentations. Me thods. Quantitative coronary arteriography was performed in 214 patien ts classified into three groups: 85 patients with chest pain syndromes and angiographically normal arteries (group 1); 21 patients with one normal vessel and at least one vessel with >50% diameter lumen narrowi ng (group 2); and 108 heart transplant recipients (group 3). Coronary vasodilatory reserve (the ratio of maximal to basal average coronary f low velocity) was measured in 416 arteries using a 0.018-in. (0.04 cm) Doppler-tipped angioplasty guide wire. Intracoronary adenosine (8 to 18 mu g) was used to produce maximal hyperemia. Results. Coronary vaso dilatory reserve was higher in angiographically normal arteries in pat ients with chest pain syndromes (group 1: 2.80 +/- 0.6 [group mean +/- SD]) than in normal vessels in patients with remote coronary artery d isease (group 2: 2.5 +/- 0.95, p = 0.04); both values were significant ly higher than those in the post-stenotic segment of the diseased arte ry (1.8 +/- 0.6, p < 0.007). Coronary vasodilatory reserve in transpla nt recipients (group 3) was higher than that in the other groups (3.1 +/- 0.9, p < 0.05 vs. groups 1 and 2) as a group and for individual ar teries. When stratified by vessel, coronary vasodilatory reserve was s imilar among the left anterior descending, left circumflex and right c oronary arteries. There were no differences between coronary vasodilat ory reserve values on the basis of gender for patients with coronary a rtery disease and transplant recipients. In group 1 (chest pain), ther e was a trend toward higher coronary vasodilatory reserve in men than in women (2.9 +/- 0.6 vs 2.7 +/- 0.6, p = 0.07). Conclusions. These fi ndings identify a normal reference range for studies assessing the cor onary circulation and post-stenotic coronary vasodilatory reserve in p atients with and without coronary artery disease encountered in the ca rdiac catheterization laboratory.