Coronary driving pressure and vasomotor tonus as determinants of coronary blood flow.

Abstract

A method is described that measures the contribution of coronary vasomotor tonus and extracoronary factors in the regulation of coronary blood flow. Coronary flow was measured from the bypassed right heart when the left ventricle pumped the entire systemic flow (method "A") and when a heart-lung machine generated systemic pressure (method "B"). In method "B," the mechanical activity and the oxygen consumption of the heart could be dissociated from systemic pres sure by the use of a balloon in the ventricle. Control measurements were performed in "uninjured" hearts; when a balloon was inflated to a left ventricular diastolic pressure of 15 mm. Hg or more, a state of "cardiac injury" supervened. The arterial oxygen content was kept above 20 to 21 vol. per cent, but the cardiac oxygen consumption varied over a wide range. Whenever hemodynamic factors changed, coronary flow was a highly correlated, straight-line function of the difference between the aortic pressure and the left ventricular pressure, which we call the "coronary driving pressure." In "injured" hearts this linearity and high correlation persisted, but the slope of the regression line increased. We conclude that coronary flow is determined by the integrated difference between the propulsive force (the fluctuating pressure head at the coronary ostia) and opposing forces (intramyocardial pressure, which is known to oppose local coronary flow whenever and wherever it exceeds intravascular pressures). Cardiac oxygen consumption and coronary blood flow were not significantly related and were, therefore, coordinated by purely mechanical pressure differentials and not by changes of coronary vasomotor tonus. However, coronary vasomotor tonus decreased markedly during arterial anoxia or after various types of cardiac injury; it increased after Pitressin.