Minimal-invasive Quantifizierung der myokardialen Mikrozirkulationsfunktion mittels Computertomographie: Die Blutvolumen-Fluss-Beziehung

The intramyocardial coronary microvasculature has an important role in regulating regional myocardial perfusion. Pathologic alterations of microvascular function may be present in early stages of coronary artery disease, myocardial hypertrophy, cardiomyopathy or systemic diseases such as arterial hypertension and diabetes mellitus. Fast computed tomography permits noninvasive simultaneous quantitation of regional intramyocardial blood volume and myocardial perfusion using indicator dilution principles. Our data indicate that especially the blood volume-to-flow relationship is sensitive enough to characterize and quantitate the functional impact of different pathologies along the coronary tree on microvascular function. This could be demonstrated for 1) acute impairment of microvascular function following coronary microembolization, 2) endothelial dysfunction induced by chronic hypercholesterolemia, 3) chronic epicardial non-significant stenoses, 4) physiologic maturation of the normal microvasculature and 5) quantification of heterogeneity of microvascular function. These findings, the methodological background and the concept itself are presented in this article. Application of the blood volume-to-flow relationship is not limited to fast-CT but may be used in any cross sectional imaging technique, such as MRI or echocardiography, as long as intramyocardial blood volume and perfusion can be quantitated simultaneously. This new noninvasive approach to the quantification of intramyocardial microvascular function may prove a useful adjunct to those imaging techniques that are used to noninvasively quantitate epicardial stenoses or regional wall motion abnormalities.