The literature is reviewed on methods to assess heterogeneity of blood flow
, substrate uptake and oxidative end energy metabolism in the normal heart,
and their interrelations. Even though the factors controlling matching on
the regional level remain largely obscure, the evidence that heterogeneous
blood flow partially correlates to indicators of metabolism in the normal h
eart is accumulating, particularly in face of a correlation between acetate
metabolism indicative of regional O-2 consumption to microsphere blood flo
w. Moreover, the partial matching cannot be explained by vascular anatomica
l differences from one region to the other, since, although fractal theory
can partially describe the branching patterns of the coronaries, vasodilati
on is similar among regions upon metabolic stimulation of the heart. It is
dissimilar among regions, so that blood flow is redistributed, upon maximum
vasodilation with adenosine or hypoxia, denoting regionally different maxi
mum vessel diameter and flow reserve. However, regionally differing tissue
composition could also contribute somewhat to regional differences in (the
need for) blood flow. It is still unknown, because of technical limitations
, how the foregoing measures relate to regional workload.