Myocardial perfusion after aortocoronary bypass surgery: measurements at rest and after administration of isoproterenol

• Published in: Circulation (New York, N.Y.) Vol. 71; no. 4; pp. 767 - 778
• Main Authors: SCHMIDT, D. H, BLAU, F. M, HENDRIX, L. J, LAXMAN KAMATH, M, RAY, G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.04.1985
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Coronary Artery Bypass - standards; Coronary Circulation - drug effects; Coronary Disease - physiopathology; Coronary heart disease; Heart; Heart Rate - drug effects; Hemodynamics; Humans; Isoproterenol - pharmacology; Medical sciences; Postoperative Period; Rest; Vascular Resistance - drug effects; Human; Pharmacologic test; Aortocoronary; Bypass; Perfusion; Surgery; Myocardium; Cardiovascular disease; Hemodynamics; Coronary vessel; Coronary heart disease
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.71.4.767

This study examined quantitative regional myocardial perfusion (RMP) measured by the washout of 133Xe at rest and after an isoproterenol challenge in 50 patients (group I) studied 8 to 14 days after they underwent saphenous vein bypass grafting to the left coronary artery, and compared this with RMP measured in the native left coronary artery in 14 patients (group II) with significant coronary artery disease and in 12 normal subjects (group III). The double product of the heart rate and aortic systolic pressure was used as an indicator of demand. The statistical significance of group comparisons was analyzed with Dunn's multiple comparisons among means test. Analysis of the data showed no significant difference among the groups with respect to aortic systolic pressure. In subjects at rest, heart rate was lower in groups II and III than in group I, and double product was lower in group II than in group I. After isoproterenol, both heart rate and double product were lower in group II compared with groups I and III, but there was no significant difference between groups I and III with respect to heart rate or double product. Mean resting RMP in group II was lower than in group I; however, results of other group comparisons were insignificant for resting parameters. After isoproterenol, mean flow (ml/100 g/min) in group I was similar to flow in group III (130 +/- 24 vs 139 +/- 26). In contrast, the average flow response after isoproterenol was significantly less in group II when compared with that in group I (105 +/- 20 vs 130 +/- 24) and with that in group III (105 +/- 20 vs 139 +/- 26). Because of differences in levels of demand with isoproterenol, the change in flow was normalized to the percent increase in double product. These data showed results similar to those above, i.e., normalized RMP in patients with coronary artery disease was significantly lower than that in normal subjects (82 +/- 41 vs 119 +/- 57) and in revascularized patients (82 +/- 41 vs 105 +/- 54). However, there was no significant difference between normal subjects and patients who had undergone surgery. To further evaluate the relationship of flow response to demand parameters, we plotted RMP/double product vs resistance. The data revealed a significant correlation between these variables in all groups both in subjects at rest and after isoproterenol.