The significance of coronary reserve in clinical heart disease

Department of Internal Medicine, University of Dusseldorf, Federal Republic of Germany.

The clinical syndrome "coronary insufficiency with normal coronary arteriogram" is found in approximately 10% to 20% of patients with exercise-induced coronary insufficiency. In most of these cases, disturbances of the coronary microcirculation are present. They can appear in vascular diseases (arterial hypertension, systemic immunopathies, immune complex vasculitis), in rheologic diseases (paraproteinemia, hyperlipoproteinemia, polyglobulia) and in disturbances of transport and diffusion of oxygen (carbon monoxide intoxication, methemoglobinemia). The clinical diagnosis is based on the usual diagnostic procedures (electrocardiogram, exercise electrocardiogram, responsiveness to nitroglycerin), as well as on newer functionally oriented diagnostic procedures (determinations of coronary blood flow and coronary vascular reserve, production of lactate, serologic findings, histology and immune histology of peripheral arteries, measurements of viscosities in both plasma and blood). Many clinically relevant disturbances in the coronary microcirculation can thus be detected and treated on a rational basis by management of the underlying main disease, that is, by treatment of the vascular, rheologic and metabolic disorders. Persistent angina pectoris in the presence of a normal coronary arteriogram does not represent an end to coronary diagnostic procedures, but introduces the clinical task of using all diagnostic possibilities to enable functional and therapeutic assessment of the coronary microcirculation.

This article has been cited by other articles:

				V. Voudris, D. Avramides, M. Koutelou, J. Malakos, A. Manginas, M. Papadakis, and D. V. Cokkinos Relative Coronary Flow Velocity Reserve Improves Correlation With Stress Myocardial Perfusion Imaging in Assessment of Coronary Artery Stenoses Chest, October 1, 2003; 124(4): 1266 - 1274. [Abstract] [Full Text] [PDF]

				F Chirillo, A Bruni, G Balestra, C Cavallini, Z Olivari, J D Thomas, and P Stritoni Assessment of internal mammary artery and saphenous vein graft patency and flow reserve using transthoracic Doppler echocardiography Heart, October 1, 2001; 86(4): 424 - 431. [Abstract] [Full Text] [PDF]

				L. Schwartz and M. G. Bourassa Evaluation of Patients With Chest Pain and Normal Coronary Angiograms Arch Intern Med, August 13, 2001; 161(15): 1825 - 1833. [Full Text] [PDF]

				M. Haude, D. Baumgart, E. Verna, J. J. Piek, C. Vrints, P. Probst, and R. Erbel Intracoronary Doppler- and Quantitative Coronary Angiography-Derived Predictors of Major Adverse Cardiac Events After Stent Implantation Circulation, March 6, 2001; 103(9): 1212 - 1217. [Abstract] [Full Text] [PDF]

				M. J. Kern Coronary Physiology Revisited : Practical Insights From the Cardiac Catheterization Laboratory Circulation, March 21, 2000; 101(11): 1344 - 1351. [Abstract] [Full Text] [PDF]

				M. J. Kern, S. Puri, R. G. Bach, T. J. Donohue, P. Dupouy, E. A. Caracciolo, W. R. Craig, F. Aguirre, E. Aptecar, T. L. Wolford, et al. Abnormal Coronary Flow Velocity Reserve After Coronary Artery Stenting in Patients : Role of Relative Coronary Reserve to Assess Potential Mechanisms Circulation, December 21, 1999; 100(25): 2491 - 2498. [Abstract] [Full Text] [PDF]

				U. E. Heidland, M. P. Heintzen, W. J. Klimek, C. J. Michel, and B. E. Strauer Acute Complications and Restenosis in Women Undergoing Percutaneous Transluminal Coronary Angioplasty. Is it Possible to Define Sex Differences and to Determine Risk Factors? European Journal of Cardiovascular Prevention & Rehabilitation, October 1, 1998; 5(5-6): 297 - 302. [Abstract] [PDF]

				J. Dieez and C. Laviades Monitoring fibrillar collagen turnover in hypertensive heart disease Cardiovasc Res, August 1, 1997; 35(2): 202 - 205. [Full Text] [PDF]

				S. Schafer, C. Schardt, U. Burkhard-Meier, R. M. Klein, M. P. Heintzen, and B. E. Strauer Angina Pectoris and Progressive Fatigue in a 61-Year-Old Man Circulation, December 15, 1996; 94(12): 3376 - 3381. [Full Text]

				W. Motz and B. E. Strauer Improvement of Coronary Flow Reserve After Long-term Therapy With Enalapril Hypertension, May 1, 1996; 27(5): 1031 - 1038. [Abstract] [Full Text]

				R. J. Gray, S. Nessim, S. S. Khan, T. Denton, and J. M. Matloff Adverse 5-Year Outcome After Coronary Artery Bypass Surgery in Blacks Arch Intern Med, April 8, 1996; 156(7): 769 - 773. [Abstract] [PDF]

				W. Motz, S. Scheler, B. Schwartzkopff, and B. E. Strauer Evaluation of Cardiac Damage in Hypertension European Journal of Cardiovascular Prevention & Rehabilitation, February 1, 1995; 2(1): 16 - 26. [Abstract] [PDF]

				M. Kelm, M. Feelisch, T. Krebber, A. Deu en, W. Motz, and B. E. Strauer Role of Nitric Oxide in the Regulation of Coronary Vascular Tone in Hearts From Hypertensive Rats : Maintenance of Nitric Oxide Forming Capacity and Increased Basal Production of Nitric Oxide Hypertension, February 1, 1995; 25(2): 186 - 193. [Abstract] [Full Text]

				S. E. Langerak, P. Kunz, H. W. Vliegen, J. W. Jukema, A. H. Zwinderman, P. Steendijk, H. J. Lamb, E. E. van der Wall, and A. de Roos MR Flow Mapping in Coronary Artery Bypass Grafts: A Validation Study with Doppler Flow Measurements Radiology, January 1, 2002; 222(1): 127 - 135. [Abstract] [Full Text] [PDF]