F. Kajiya G.A. Klassen J.A.E. Spaan J .I.E. Hoffman (Eds.) Coronary Circulation Basic Mechanism and Clinical Relevance With 141 Figures, Including 4 in Color Springer-Verlag Tokyo Berlin Heidelberg New York London Paris Hong Kong Dr. FUMIHIKO KAlIYA Prof. Jos A. E. SPAAN Department of Medical Department of Medical Physics Engineering and Systems University of Amsterdam Cardiology 1105 AZ Amsterdam, Kawasaki Medical School The Netherlands Kurashiki, 701-01 Japan Dr. JULIEN I. E. HOFFMAN Dr. GERALD A. KLASSEN Department of Pediatrics and Departments of Medicine, Cardiovascular Research Physiology and Biophysics Institute Dalhousie University University of California and Maritime Heart Centre San Francisco, CA 94143, USA Victoria General Hospital Halifax, N.S. B3H2Y9, Canada Associate Editors: K. ONODERA, Y. MARUYAMA, H. TOMOIKE, K. TSUJIOKA ISBN-13:978-4-431-68089-5 e-ISBN-13:978-4-431-68087-1 DOl: 10.1007/978-4-431-68087-1 Library of Congress Cataloging-in-Publication Data Coronary circulation: basic mechanism and clinical relevance/F. Kajiya ... let al.) (eds.). p. cm. Includes index. ISBN-13:978-4-431-68089-5 (U.S.) 1. Coronary circulation. 2. Coronary heart disease. I. Kajiya, Fumihiko. [DNLM: 1. Coronary Circulation. WG 300 C82154) QP108.C66 1990612. 1' 7--dc20 DNLM/DLC This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. © Springer-Verlag Tokyo 1990 Softcover reprint of the hardcover 1st edition 1990 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every indi- vidual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typesetting: Asco Trade Typesetting Ltd., Hong Kong Preface Coronary heart disease is one of the major health problems in indus- trialized nations because of its high incidence and severity. Recent innovations in medical and surgical treatment of coronary heart dis- ease have increased the importance of accurate diagnostic methods for determining the severity of coronary disease, identifying potential treatment alternatives, and evaluating the results of treatment. Great advances have also been made in basic research on coronary circula- tion and its interaction with myocardial contraction and relaxation and neural and humoral control. With respect to these developments, the papers included in the present monograph deal with important topics concerned with the basic mechanism of coronary circulation as well as ones of clinical relevance. It is directed toward physicians (cardiologists, cardiac surgeons, cardiac radiologists, anestheologists, and others) and basic scientists (e.g., physiologists, bioengineers). We would like to em- phasize the importance of a multidisciplinary approach in which basic scientists and clinicians work closely together. This volume consists of nine chapters. Chapter 1 contains macro- scopic and microscopic descriptions of coronary vascular anatomy, which is closely related to the functions of coronary circulation. In Chap. 2 two methods in current use to evaluate phasic coronary blood velocity waveforms are presented, i.e., the laser Doppler and ultrasound Doppler methods. Chapter 3 describes the mechanical properties of coronary circulation, a knowledge of which is indispens- able for an understanding of coronary arterial and venous blood flow velocity waveforms in relation to cardiac contraction and relaxation. The diastolic pressure-flow relationship is also discussed in this chap- ter. Chapter 4 is concerned with the transmural distribution of coron- ary flow with special reference to the higher vulnerability of the en- domyocardium to ischemia, while Chap. 5 focuses on the pressure and flow in coronary microcirculation concerning one recent topic of interest, "vascular segmentation." Chapter 6, which is on the control of coronary circulation, presents new information regarding the sym- pathetic control of coronary circulation and discusses some current vi Preface topics of humoral control and models based on the mass balance be- tween O2 supply and demand. Animal models used for investigation of coronary circulation in cardiac hypertrophy and for provocation of coronary spasm are dealt with in Chap. 7. Chapter 8 focuses on coronary collateral circulation, including anatomical considerations, the mechanism for collateral growth, the rate of development of collateral perfusion, and the effects of interventions on collateral hemodynamics. The five papers constituting Chap. 9 present exam- ples of clinical evaluation of coronary circulation, including coronary reserve, the hemodynamics of coronary stenosis, aortic valve dis- eases, syndrome X, and velocity profiles in coronary bypass grafts. Many of the contributors to this book were participants in the 8th International Conference of the Cardiovascular System Dynamics Society (CSDS) held in Osaka, Japan in 1987 (chairman, F. Kajiya; secretary general, M. Hori). On that occasion, Drs. F. Kajiya, G. A. Klassen, and J. A. E. Spaan discussed the publication of a mono- graph on coronary circulation and outlined the contents. Dr. J. I. E. Hoffman, who could not attend the Osaka Conference, was invited to be the editor of this book, and Drs. K. Onodera (chairman of the satellite symposium), H. Tomoike, Y. Maruyama, and K. Tsujioka were asked to serve as associate editors. Whereupon, the contents of this volume were finalized. The editors are greatly indebted to all the authors who have contributed to this book in spite of their busy schedules. Special thanks are also due to Mayumi Yokomizo, Mari Tanaka, and Yukiko Sato for their excellent secretarial work. The editors are also grateful to the members of the CSDS (presi- dent: Professor T. Kenner, University of Graz) who gave us the opportunity to publish this book. We especially wish to acknowledge our gratitude to the late Dr. Kiichi Sagawa, Department of Bio- medical Engineering, Johns Hopkins University for his continuous guidance, and we would like to express our sincerest condolences to his family. Finally, it has been a pleasure to work with Springer-Verlag Tokyo. They provided us with excellent advice regarding many aspects of this project and provided us with an outstanding language editor. Okayama, April 1990 FUMIHIKO KAJIYA In Memorial We were saddened to learn of the death of Dr. Kiichi Sagawa, a valued member of the CSDS and a bioengineer of extraordinary abil- ity. His studies on ventricular mechanics culminated in the develop- ment of the concepts of ventricular elastance, one of the most fruitful concepts ever developed for understanding the nature of myocardial contractility. His students can be found all over the world and can testify to his ability and unfailing kindness to everyone. We are all the poorer for his loss and would like to offer our sympathy to his family. As the time of publication of this volume approached, we also learned with great regret of the death of Dr. Melvin L. Marcus. The author of the outstanding book The Coronary Circulation in Health and Disease, Dr. Marcus was one of the most eminent investigators of the coronary circulation. He was noted for his critical ability, for knowing what studies would prove to be important, and for develop- ing the techniques needed to solve major problems in the coronary circulation. He led one of the most successful groups of cardiovascu- lar investigators in the world and was responsible for the training of many of the current leaders in the field. He will be missed by all his friends and collaborators, and the editors offer their sympathy to his family on their great loss. Editors List of Contributors T. Akiyama 197 M. Nakamura 245 K. Ashikawa 155 S. H. Nellis 173 R. J. Bache 235 I. Ninomiya 197 W. M. Chilian 55,173 N. Nishiura 197 J. Dankelman 75,221 Y.Ogasawara 43,89,295 D. Franklin 267 K. Onodera 267 M. Fujita 267 D.Opherk 313 T. Fujiwara 295,305,325 J. D. Rossen 281 M. Goto 89 R. D. Sarazan 267 J. Hartley 267 K. W. Scheel 255 O. Hiramatsu 43,89,169 G. Schuler 313 J. I. E. Hoffman 109,141 P. Sipkema 99 T. Honda 197 J. A. E. Spaan 75,221 F. Kajiya 43,89,169,295,305, H. G. Stassen 75 325 T. Suzuki 155 H. Kanatsuka 155 S. Tadaoka 43 T. Katsumura 305 M. Takahashi 267 G. A. Klassen 211 T. Takishima 127,155 W. Kiibler 313 R. J. Tomanek 3 S.M. Layne 55,173 H. Tomoike 245 M. L. Marcus 191,281 K. Tsujioka 43,89,295 Y. Maruyama 127 I. Vergroesen 221 S. Matsuoka 295 W. Waas 313 D. McKown 267 Y. Wada 89 M. McKown 267 N. Westerhof 99 A. Mikuniya 267 M. D. Winniford 281 K. Mito 43,169 M. Zamir 15 Table of Contents 1. Anatomy of Coronary Circulation Anatomical Principles of the Coronary Circulation R. J. TOMANEK .......................................... 3 Flow Strategy and Functional Design of the Coronary Network M. ZAMIR ............................................... 15 2. Measurements of Epicardial Coronary Artery and Vein Flow Velocity Waveforms on Left and Right Ventricles Evaluation of Coronary Blood Flow by Fiber-Optic Laser Doppler Velocimeter F. KAJIYA, O. HlRAMATSU, K. MITo, S. TADAoKA, Y. OGASAWARA, K. TsUJIOKA............................. 43 Ultrasonic Measurements of Coronary Blood Flow W. M. CHILIAN, S. M. LAyNE............................ 55 3. Mechanical Properties of Coronary Circulation and Its Contribution to Coronary Hemodynamics Coronary Circulation Mechanics J. DANKELMAN, H. G. STASSEN, J. A. E. SPAAN 75 Functional Characteristics of Intramyocardial Capacitance Vessels and Their Effects on Coronary Arterial Inflow and Venous Outflow K. TSUJIOKA, M. GOTO, O. HIRAMATSU, Y. WADA, Y. OGASAWARA, F. KAJIYA ............................... 89 Input Impedance of the Canine Coronary Arterial Tree N. WESTERHOF, P. SIPKEMA ............................... 99 x Table of Contents Pressure-Flow Relationships of the Coronary Arteries J. I. E. HOFFMAN ........................................ 109 Effect of Ventricular and Extraventricular Pressure on the Coronary Artery Pressure-Flow Relationship Y. MARUYAMA, T. TAKISHIMA ............................ 127 4. Transmural Myocardial Perfusion Transmural Myocardial Perfusion J.1. E. HOFFMAN ••••••••••••• 0 ••••••••••••••••••• 0 •••••• 141 5. Coronary Microcirculation Characteristics of Velocity Waveform and Radius in Epimyocardial Microvessels in Beating Left Ventricle K. ASHlKAWA, H. KANATSUKA, T. SUZUKI, T. TAKISHIMA ... 155 Evaluation of the Velocity Waveform in Intramyocardial Small Vessels O. HlRAMATSU, K. Mrro, F. KAlIYA ................... " .. 169 Microvascular Pressure Profiles in the Left and Right Coronary Circulations W. M. CmLlAN, S. M. LAYNE, S. H. NELLIS ............... 173 6. Control of Coronary Circulation Mechanisms of Control in the Coronary Circulation M. L. MARCUS ........................................... 191 Sympathetic Control of the Coronary Circulation I. NINOMIYA, T. AKIYAMA, T. HONDA, N. NISHIURA ........ 197 Humoral Control of the Coronary Circulation G. A. KLASSEN .......................................... 211 Static and Dynamic Control of the Coronary Circulation I. VERGROESEN, J. DANKELMAN, J. A. E. SPAAN ........... 221 7. Coronary Circulation in Pathophysiological Conditions Coronary Circulation in Myocardial Hypertrophy R. J. BACHE ............................................. 235 Table of Contents xi Provocation of Coronary Spasm and Its Pathophysiology: Experimental Studies H. TOMOIKE, M. NAKAMURA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 8. Coronary Collaterals Development of Coronary Collaterals K. W. SCHEEL ........................................... 255 A Conscious Animal Model for Studies of Coronary Collateral Blood Flow Dynamics D. FRANKLIN, A. MIKUNIYA, M. FUJITA, M. TAKAHASHI, M. McKOWN, D. McKOWN, J. HARTLEY, R. D. SARAZAN, K. ONODERA ...................•........................ 267 9. Clinical Evaluation of Coronary Circulation Coronary Reserve in the Human Coronary Circulation M. L. MARCUS, M. D. WINNIFORD, J. D. ROSSEN.......... 281 Flow Dynamics in Coronary Stenosis F. KAlIYA, K. TSUJlOKA, Y. OGASAWARA, S. MATSUOKA, T. FUJIWARA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Characteristics of Coronary Artery Blood Velocity Waveforms in Aortic Stenosis and Regurgitation T. FUJIWARA, T. KATSUMURA, F. KAlIYA.................. 305 Coronary Circulation in Patients with Typical Angina Pectoris but Normal Coronary Angiograms W. WAAS, D. OPHERK, G. SCHULER, W. KUBLER.......... 313 Blood Velocity Waveforms in Coronary Bypass Grafts T. FUJIWARA, F. KAJlYA .................................. 325 Index of Key Words. . .. . .. . . . . . .. . ... . ... .... .. .. . .. . .. ... .. 335