Myocardial blood flow: clinical application and recent advances

Abstract

The uptake of oxygen and metabolic substrates by the myocardium is dependent on myocardial blood flow and also on the avidity or extraction of oxygen and substrates by the myocardium. The delivery of oxygen and substrates to the myocardium is therefore an important component in the preservation of normal contractile function. Regional changes in myocardial blood flow frequently occur in patients with coronary artery disease and these are followed by changes in left ventricular function that are transient in angina or permanent in infarction. Because of the morbidity and mortality associated with these changes in ventricular function, accurate measurement of myocardial blood flow is of great clinical importance. Many methods for measuring myocardial blood flow have been described [1]. These can be classified as (1) indicator-dilution techniques using inert gases or thermodilution, and (2) radioisotope techniques using monovalent cations, ammonia, carbon dioxide, water or microspheres. Each of these methods suffers from technical and theoretical limitations of the measurement as well as problems in the clinical applicability. This chapter will review the available methods for the clinical measurement of myocardial blood flow and will discuss their advantages and limitations when applied to clinical problems. Major emphasis will be placed on techniques which are presently in wide use as well as on newer but promising methods.KeywordsMyocardial PerfusionMyocardial Perfusion ImagingMyocardial Blood FlowMonovalent CationRegional Myocardial PerfusionThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.