Cutaneous and coronary flow reserve in patients with microvascular angina

• Published in: Journal of the American College of Cardiology Vol. 20; no. 1; pp. 78 - 84
• Main Authors: Sütsch, Gabor, Hess, Otto Martin, Franzeck, Ulrich Klaus, Dörffler, Thomas, Bollinger, Alfred, Krayenbühl, Hans Peter
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1992; Elsevier Science
• Subjects: Adult; Angina Pectoris - drug therapy; Angina Pectoris - physiopathology; Biological and medical sciences; Cardiology. Vascular system; Coronary Circulation - physiology; Coronary heart disease; Exercise; Female; Heart; Humans; Male; Medical sciences; Microcirculation; Middle Aged; Regional Blood Flow; Skin - blood supply; Human; Reserve; Coronary artery; Cardiovascular disease; Exploration; Angina pectoris; Normal; Coronary heart disease; Blood flow; Thermodilution; Skin; Hemodynamics; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(92)90140-I

Microvascular angina is characterized by exercise-induced angina in patients with normal coronary arteries and reduced coronary flow reserve. Recently, a generalized disorder of abnormal vascular reactivity in microvascular angina has been postulated. Therefore, coronary flow reserve was determined by the coronary sinus thermodilution technique and compared with the cutaneous flux ratio in 6 control subjects (group 1) and 12 patients with microvascular angina (group 2). Coronary flow reserve was calculated from maximal coronary flow after 0.5 mg/kg of dipyridamole divided by flow at rest. Cutaneous flow ratio was estimated by laser Doppler fluxmetry (right forearm) before and after 4 min of suprasystolic blood pressure occlusion. Coronary flow at rest was identical in the two groups, but after maximal vasodilation with dipyridamole, coronary flow was higher in group 1 than in group 2 (p < 0.05). Coronary flow reserve differed significantly between the two groups (2.9 in group 1 and 1.3 in group 2; p < 0.001). Cutaneous Doppler flux at rest was higher in group 1 than in group 2 (p < 0.05). However, the hyperemic response was identical in both groups. It is concluded that the cutaneous flux ratio in patients with microvascular angina is not impaired. Local peripheral vasomotor tone appears to be increased in patients with microvascular angina because cutaneous flow at rest is reduced. Thus, a generalized disorder of abnormal vascular reactivity cannot be confirmed in patients with microvascular angina.