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Am J Physiol Heart Circ Physiol 279: H2634-H2640, 2000;
0363-6135/00 $5.00
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Vol. 279, Issue 6, H2634-H2640, December 2000

Persistent but reversible coronary microvascular dysfunction after bypass grafting

Nicos Spyrou1, Masood A. Khan2, Stuart D. Rosen2, Rodney Foale3, D. Wyn Davies3, Franco Sogliani3, Rex De Lisle Stanbridge3, and Paolo G. Camici2

1 Royal Berkshire and Battle Hospitals, Reading; and 2 Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, and 3 Clinical Cardiology, St. Mary's Hospital, Imperial College School of Medicine, London, United Kingdom

The effect of coronary artery bypass grafting (CABG) on absolute myocardial blood flow (MBF) has not been investigated previously. MBF (ml · min-1 · g-1) was measured at rest and during hyperemia (0.56 mg/kg iv dipyridamole) using H215O and positron emission tomography in eight patients with three-vessel disease before surgery and 1 and 6 mo after full revascularization. Baseline MBF was 0.87 ± 0.12 preoperatively and 1.04 ± 0.14 and 0.95 ± 0.13 at 1 and 6 mo after CABG, respectively (P < 0.05, 6 mo vs. preoperatively). Hyperemic MBF was 1.36 ± 0.28 preoperatively and increased to 1.98 ± 0.50 and 2.45 ± 0.64 at 1 and 6 mo after CABG, respectively (P < 0.01, 6 mo vs. preoperatively). Coronary vasodilator reserve (hyperemic/baseline MBF) increased from 1.59 ± 0.40 preoperatively to 1.93 ± 0.13 and 2.57 ± 0.49 at 1 and 6 mo, respectively (P < 0.05, 6 mo vs. preoperatively). Minimal (dipyridamole) coronary resistance (mmHg · min · g-1 · ml-1) fell progressively from 59.37 ± 14.56 before surgery to a nadir of 35.76 ± 10.12 at 6 mo after CABG (P < 0.01 vs. preoperatively). The results of the present study confirm that CABG improves coronary vasodilator reserve progressively as a result of reduction in minimal coronary resistance. These data suggest persistent microvascular dysfunction that recovers slowly after surgery.

coronary artery disease; coronary microcirculation; myocardial blood flow; positron emission tomography; coronary vasodilator reserve


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