Hemodynamic significance of the length of a coronary arterial narrowing

Abstract

The hemodynamic significance of the length of a coronary arterial narrowing is unclear. Accordingly, the influence of the length of a given coronary narrowing on coronary hemodynamic responses was studied in 14 dogs. Recordings were made as short fixed diameter reductions were progressively lengthened to 5, 10 and 15 mm by the addition of plastic occluders. Resting coronary blood flow decreased and pressure gradients developed across short (snare) narrowings greater than 80 percent (critical stenosis). Short 40 to 60 percent narrowings had no significant resting hemodynamic influence, but increasing their length to 10 and 15 mm consistently resulted in significant pressure gradients and flow reductions. Reactive hyperemic coronary blood flow expressed as repayment of flow debt (after 10 seconds of coronary occlusion) decreased progressively as these narrowings were lengthened. The effect of 15 mm long narrowings on resting and reactive hyperemic flows was similar to that of short 90 percent narrowings. These data indicate that there is uncertainty about the significance of coronary diameter reductions previously considered hemodynamically unimportant. In our studies, significant changes in resting and reactive hyperemic coronary flows and resting pressure gradients occurred as the length of a given degree of narrowing was increased.