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Phasic coronary flow pattern and flow reserve in patients with left bundle branch block and normal coronary arteries

^a Department of Cardiology, University Hospital of Heraklion, Crete, Greece
^* Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece

View larger version (13K): [in a new window]   Figure 1 Time to maximum peak flow velocity (Time to MPV) for patients with left bundle branch block with (Group I) and without (Group II) scintigraphic perfusion defects, and for controls. Individual data points: tagged circles indicate where values from two or more patients almost coincide.

View larger version (16K): [in a new window]   Figure 2 Acceleration plotted against the maximum peak flow velocity (MPV) at baseline (A) and at maximal hyperemia (B). A significant correlation existed between these two variables. White squares: control subjects; black squares: patients with left bundle branch block. In one control subject, sufficiently good quality recordings could not be obtained at hyperemia and so only 10 points are shown in B.

View larger version (12K): [in a new window]   Figure 3 Coronary flow reserve (CFR) in the left anterior descending coronary artery for patients with left bundle branch block with (Group I) and without (Group II) scintigraphic perfusion defects, and for controls. Individual data points: tagged circles indicate where values from two or more patients almost coincide.

View larger version (23K): [in a new window]   Figure 4 Schematic of intramyocardial pressure (IMP) in the septum and left anterior descending artery (LAD) flow in dogs, showing controls and animals with pacing-induced left bundle branch block (LBBB). In the latter group the peak pressure moves from systole to early diastole, while the maximum peak diastolic flow occurs later and the acceleration of flow is lower than in the control group. Ts = systolic flow; Td = diastolic flow. From Ono S, et al: Circulation 1992;85:1125–31 (Reproduced with permission).

View larger version (154K): [in a new window]   Figure 5 Left anterior descending coronary artery flow-velocity pattern from a control subject and from patients with left bundle branch block in Groups I and II, at baseline and during maximal hyperemia. The time to maximum peak velocity at baseline is longer and the acceleration less in the Group I and Group II patients than in the controls. These differences persist during hyperemia.

View larger version (82K): [in a new window]   Figure 6 Left anterior descending coronary artery flow velocity recording in a patient from Group I during atrial pacing. (A): at baseline under pacing at 100 beats/min; (B): during maximal hyperemia under pacing at 100 beats/min; (C): during maximal hyperemia under pacing at 140 beats/min. The reduction in cycle length at the higher pacing rate is at the expense of the diastolic flow, indicating that pacing-induced tachycardia leads to a reduction in time-averaged peak flow velocity (as early diastolic flow did not increase significantly) and hence a reduction in coronary flow reserve.