Amsterdam, Ezra A.; Mason, Dean T.
December 1977
Angiology;Dec1977, Vol. 28 Issue 12, p844
Academic Journal
Angina pectoris is the clinical manifestation of a disparity between myocardial oxygen demand and supply. Reduced myocardial oxygen supply is typically caused by obstructive coronary atherosclerotic disease, and cardiac oxygen consumption (MVO2) is principally determined by heart rate, blood pressure, ventricular volume, and myocardial contractility. Because these hemodynamic factors are closely related to MVO2, they have been applied in indexes utilized in its indirect assessment. Coronary blood flow, in turn, varies directly with MVO2, and therefore a means of estimating MVO2 would also yield information regarding coronary flow. Indirect approximation of MVO2 by indexes of heart rate X blood pressure product has been useful in elucidating mechanisms of angina and therapy in patients with coronary artery disease. These indexes demonstrate a constancy at the point of angina in a given individual, consistent with occurrence of myocardial ischemia at a critical threshold of MVO2 above which regional myocardial perfusion cannot rise. Although medical therapy of angina enhances functional capacity, it reduces indirect indexes of MVO2-at given levels of exercise; this reduction indicates attenuation of the circulatory response to stress. That myocardial revascularization is associated with an increase in MVO2 by indirect assessment suggests augmented myocardial perfusion. Indirect indexes of MVO2, based on conveniently measured hemodynamic factors, are useful in the evaluation of angina therapy. However, because they do not account for several major determinants of MVO2, findings based on the indirect approach must be interpreted with appropriate caution.


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