Subject Index

Acute myocardial ischemia - -, Cytosolic 5'-nucleotidase 49 effect of arterial and peripheral coro• - -,hypoxia 49 nary pressures 316,317,318,322 - -, intracellular accumulation 52 -- -, - f3-adrenoceptor blocking - -, myocardial S-adenosyl-homocys- agents 321,322 teine content 50,51 -- -, - methoxamine 320 Adenosine levels, myocardial transmural -- -, - nitroglycerin 320,321,322, gradient 46 323,324 -- in systole and diastole 43,44 -- -,- noradrenaline 317,318,322 Adenosine production, aortic constric- -- -, - oxyfedrine 320,321,322 tion 40 - -, - reducing heart rate and myo- - -, exercise 42 cardial oxygen consumption 321,322 - -, myocardial oxygen demand 40 - -, - reducing left ventricular m• - -, stellate ganglia stimulation 42 ling pressures 320,321,322 Albumin -- -, drug-induced changes in myo• 125 I-labeled-albumin uptake in the cardial blood flow 313 vessel wall 4 -- -, limited coronary arteriolar Angina pectoris in patients with normal reserve 314 coronary angiogram -- -, loss of myocardial blood flow angiographic findings 258 autoregulation 319 --- -, coronary vascular reserve -- -, myocardial vascular resistance 257,258,262,263,267,268,269, 319 270,271,272,273,274,281,282, -- -,xenon-133 washout 313 296,297 Abnormal ECG of unknown etiology, --- -, determination of coronary hemodynamic studies 288,289,290 reserve 267, 268 --- -, light and electron microscopic -- -, disturbances in coronary changes 289,291 microcirculation 266 --- -, metabolic studies 289,290, -- -, electrocardiographic changes 292,293,298,299 288,289 --- -, morphological studies 288, --- -, enhancement of extracoro• 289,291 nary resistance 274 --- -, radionuclide studies 289 --- -, follow-up 260, 261 --- -, thallium-201 perfusion -- -, hypertenSive heart disease imaging 289 269,270 Adenosine formation 39 -- -, myocardial metabolism -, adenosine concentration at the 259,260,262,263,264,298,299 arteriolar wall 53

347 -- -, - uptake or release oflactate --- -, - reversible myocyte injury 258,259,260,264,298,299 94 -, paraproteinemia Waldenstrom Capillary flow, axial migration of red cells 280 27 -, pathogenetic factors 262,263 - -, blood flow velocity 57,308 -, reduced coronary reserve - -, cocurrent and countercurrent 296,297 arrangement 57 -- -, systemic immunopathies -, "dynamic hematocrit" 27 270,271,272,273,276,277 -, hydrodynamic disturbance effect of Arterial supply of the heart wall erythrocytes 28 centripetal arrangement 17 -, phasic flow patterns 72 Arterial wall - -, shear-dependent deformation of macromolecule transport 3 red cells 28 - -, model of mass transport 10 Capillary perfusion 31 - -, transport properties 3 Capillary permeability, bolus injection - -, uptake of albumin 3 method for estimation of substrate Arterial wall mass transport transfer of the capillary wall 105 role of convection 11 -, changes in capillary fine structure --- -, - diffusion 11 and function during myocardial Artery perfusion (in situ) 4,5 ischemia 87 Assessment of regional coronary blood -, endothelial diffusion limitation of flow, xenon residue detection tech• cardiac substrate supply 104, 108 nique 180 -, - glucose transfer mechanisms 105 Assessment of regional myocardial per• -, structure of normal myocardial fusion, krypton-81m 194,196 capillaries 88, 89 -- -, N-I3 ammonia 170 -, washout oflabeled sucrose 104 -- -, - as an indicator of myo- Coarctation of the aorta, electron micro• cardial blood flow in man 175, 176, scopy of myocardial biopsies 253, 177 254,256 - -, morphological changes in small "Border zone" of myocardial ischemia, coronary arteries and arterioles 253, 254,256 creatine kinase depletion 142 -- -, structural changes of the coro• - -, focal zone of discordance 147 nary microcirculation 253 - -, separately coloured silicone rub- Collateral circulation, capability and ber 144 limitation 21,22 - -, time course of its development 24, Coronary blood flow 39 25 -- -, during myocardial ischemia 85 Coronary anastomoses, arterial anasto• -- -, phasic changes 62 moses in the normal heart 20 Capillary changes in ~vere ischemia, -, - communications in man 19 no-reflow phenomenon 93 -, importance of limiting infarct size -- -, morphological alterations of 21 the endothelium 89,90,95,97 -, limitation of reserve capacity for -- -, with irreversible myocyte increased blood flow 22 injury 94,95 - -, septal anastomoses 18

348 - -, subendocardial plexus 18 - -, interconnected capillaries 144 - -, superficial anastomoses 18 - -, intermediate zone of ischemic Coronary anastomoses-enlargement, tissue ("border zone") 141 dynamic factors related to blood flow - -, overlapping capillaries 144 21 - -, sharp boundary between normal - -, pathogenetic factors 21, 22 and necrotic tissue 142,145,147 Coronary artery disease, coronary vascular Diabetic microarteriopathy 246 reserve 258,262,263,264,268,269, 273 - -, decrease of regional myocardial Eicosapentaenoic acid 37 perfuSion during atrial pacing 196 Erythrocyte rheology, cell shape 29,30 - -, disturbance of regional myocar• -, hyperosmolarity 32 dial perfusion 194, 195 -, membrane rotation 30 - -, exercise tests 194, 195, 196 -, red cell deform ability 30 Coronary vascular reserve, argon method -, rigidified red cells 33,34 258,268 -, shear stress 35 -- -, responsiveness to dipyridamole - -, viscous resistance 29, 34 275 Coronary vasodilators, in the acutely ischemic myocardium 314 Fahraeus-Lindqvist effect 27 -, blood flow velocity in the terminal Flow properties of the blood, erythro• vascular bed 308,309,310 cytes 26 -, dipyridamole 305,306,307,308, 309,310 Free fatty acids, fatty acid turnover in -, distances of perfused capillaries normal and ischemic myocardium 222 308,309,310 -- -, pharmacokinetics of radioactive• -, effect of intracoronary nitroglyc• ly labeled FFA 221 123 erin 311 - -, regional accumulation of 1_ -, nitrogylcerin 305,307,308,309, heptadecanoic acid (IHA) 218 310,311 - -, uptake and elimination kinetics -, regional myocardial oxygen supply 216 309,312 -, small vessel diameters 306,307,309 -, -- pressures 306,307,309 Hemodilu tion Coronary vasodilators in acute myocardial adequacy of myocardial blood supply oxygen consumption 315 341 -- -, nutritional and non• -, augmentation of venous return 337 nu tritional blood flow 315 -, circulatory effects (coronary circula- tion) 329,341 -,- - (systemic) 328,337,341 Determinants of infarct dimensions, close -, compensatory mechanisms 334 correlation between myocardial necro• -, coronary dilatory capacity 342,343 sis and tissue at risk 147 -, effect on cardiac output 330,341 - -, endcapillary network as termi• -, - coronary and peripheral resistance nation of coronary artery perfusion 330,341 field 144 myocardial blood flow 341

349 -, in experimental myocardial infarction - -, micropuncture 58,306,307 334,335 - -, pressure measurements 58,64, -, hyperperfusion of tissue 328,329,337 306,307 -, improvement of flow conditions of - -, small coronary artery pressures the blood 344 58,67,68 -, increase in coronary blood flow 329, - -, - vein pressures 58,67,68,84, 341 306,307 -, limitation of indication 345,346 - -, - vessel diameters 57,65,66, -, myocardial oxygen consumption 329, 67,72,305,306 330,331,332,333,339 -,- -pressures 61,84,306,307 -, oxygen delivery to the tissues 334,339 - -, technical difficulties 56 -, - extraction rate 334,339 -, - transport capacity 334 Krypton-81 m, measurements of regional -, peak reactive hyperemia flow 342,343 myocardial perfusion 194, 196 -, subendo/subepicardial flow ratio 342 -, stress single-photon omograms 196, -, transmural distribution of coronary 197 reserve 343,344,346 Hemodilution in experimental myocardial infarction, collateral flow 335,336, Left bundle branch block, morphologic 337 findings 289 -- -, hemodynamic data 335,341 Lupus erythematosus, myocardial lesions -- -, regional myocardial perfusion 276 335,336 - -, vascular lesions 276 Hemostasis, platelets 33 -, red cells 33 Hypertensive heart disease, morphologic Microvascular changes following transient alterations 241,242,243,245,247 myocardial ischemia, albumin activity - -, pressure-volume characteristics in the ischemic myocardium 102 of myocardial resistance vessels 276 -, ster-labeled erythrocytes 98, - -, reduction of coronary vascular 100 reserve 269,270 -, 3H-Diisopropyl fluorosphos• phate-Iabeled platelets 98, 100 -- -, during early reperfusion 98 In vivo microscopic studies, capillary flow -- -, intracellular accumulation of directions 59 liposomes 99 - -, effect of acute coronary occlu• -- -, retention of erythrocytes sion 68,69, 70 100,101 - -, - coronary vasodilators 305, Microvascular permeability to macro• 306,307,308,309,310 molecules 101 - -, electromechanical micromanipu• Morphology of the myocardial micro- lator 64,65 circulation, anastomotic channels 15 -, epi-illumination 57,63,305,306 -, anatomical supply vessels 15 -, fluorescence microscopy 57,306 -, mural arteries 15 -, free-motion technique 61 -, - supply channels 16 -, light source and illumination -, subendocardial arterial plexus 56,57,62 16

350 Myocardial adenosine release, homocys• -, ratio ofFDG concentration to myo• teine 54 cardial blood flow 211,212, 214 Myocardial biopsy, in coarctation of the -, release of metabolic substances 137 aorta 253 -, substrate delivery 120 - -, in patients with abnormal EeG of -, three-dimensional geometry 149 'unknown etiology 288,289 -, uptake of carbon substrates 124 - -, in syndrome X 283,284,286,296, -, - of compounds 137 299,300,301 -, - of radiochemical compounds 13 7 Myocardial capillaries, diameters 26 Myocardial ischemia (border zone), abrupt - -, hemodynamic parameters 26 gradient for NAD reduction 153 Myocardial capillary recruitment, active -, coronary flow studies 155 blood flow 114 -, effect of drugs 164 - -, capillary permeability surface• -, electroradiographic studies 157 area product 109, 117 -, gradients of flow or diffusion -, capillary transit times 114 across the ischemic zone 153 -, differential dilution curves 117 -- -, histochemical and ultra• -, during vasodilation 110, 113 structural studies 154 -, fractional extraction of sodium -- -, metabolic studies 158, 159 and glucose 110, 117 -- -, polarographic and surface - -, magnitude of capillary reserve fluorescence studies 153 111 -- -, role of the coronary circula• - -, multiple tracer dilution method tion 150,151 109,110 -- -, temporal considerations - -, transcapillary exchange of sodi• 150,152 um during vasodilation 113 Myocardial thallium e04T1) uptake, func• - -, variation of capillary surface tion of both flow and metabolism area and density 109,115 166,168 Myocardial ischemia, alterations in free - -, inhibition by extracellular potas• fatty acid metabolic pathways 223, sium 166 226 - -, inhibition by ouabain 165 -, assessment of metabolic changes N-13 ammonia, correlation between tissue 208,209,210 concentrations and myocardial blood -, availability offatty acids 123 flow 171,172 -, breakdown of energy-rich phos- -, extraction fraction 173, 174 phates 137 -, factors influencing the uptake and -, border zone of intermediate injury retention ofN-13 ammonia in myo- . 149 cardium 173 -, effect of insulin on glucose utiliza• -, kinetics of uptake and removal 174, tion 121,122 175 -, extraction ratios in the normal and -, metabolic trapping 175 ischemic myocardium 136, 137 -, glycolytic rate 121 Oxygen-IS, fractional uptake 203 -,inhibition of glucose utilization 121 Oxygen supply to the myocardium, con- -, - metabolic pathways 123 vective and diffusional O2 transport -, metabolic changes 136 119 -, metabolic markers 137 - -, local O2 consumption 119

351 Platelet aggregation 35 --- -, nonhemorrhagic infarction Positron emission computed tomography, (early stages) 82 calculation of regional glucose utiliza• --- -, no-reflow phenomenon 85, tion rates 208 86,87 --- -, fluorine-18-2-deoxyglucose --- -, radioactive tracer micro• 207 spheres 76 -- -, free fatty acids 216,217 --- -, reactive hyperemia 75,81 -- -, myocardial perfusion and --- -, temporary ligation of two glucose images 210 marginal branches 76, 77 --- -,N-13 ammonia 170 --- -, transmural differences of Prostaglandin synthesis, cyclo-oxygenase hyperemic response 77,78,79,80 inhibitions 37 Regional myocardial fractional oxygen - -, prostacyclin 36 extraction, functional images of deliv• - -, thromboxane A2 36 ered and utilized oxygen 203 Pyruvate oxidation, adrenergic stimula• --- -, oxygen-IS hemoglobin tion 128, 129 201,202 - -, effects of noradrenaline and work --- -, oxygen-IS labeled H20 load 130 201,202 -, inhibition by J3-hydroxybutyrate Regional myocardial free fatty acid me• 130,131 tabolism in congestive cardiomyo• -, left ventricular function 126 pathy 219,221 - -, myocardial oxygen consumption ---- in coronary artery disease 218 126,128 --- -, functional image of IHA eli" - -, uncoupling effect of octanoate mination rates 220, 224 129,130 --- -, IHA accumulation and elimi• nation rates 219 Rheological aspects, effect of hemodilu• --- -, mechanisms of alterations of tion on the marginal zone of ischemic IHA elimination rates 223 tissue 328,334 --- -, in vivo studies using radioac• -, hemorheological factors in micro• tively labeled free fatty acids 216 vascular perfusion 325 Regional myocardial glucose metabolism, - -, limited isovolemic hemodilution PCT images of myocardial FDG con• 325,326,327 centration 209,210 -, fluidity of blood 326,327 -, peT imaging 207 -, rationale for therapeutic hemodilu- --- -, uptake of exogeneous glucose tion 327,328 208 - -, red cell deform ability and aggrega• --- -, relationship between regional tion 327 myocardial blood flow and FDG con• - -, relation between shear stress and centrations 210, 211 "flow properties" of red cells 327 Regional myocardial ischemia, effects of - -, variability of blood viscosity 326 reperfusion 91 Regional myocardial blood flow following -- -, light and electron microscopy 88 reperfusion, hemorrhagic infarction -- -, morphological changes of capil- (advanced stages) 83 laries 90 --- -, mitochondrial dense bodies -- -, no-reflow phenomenon 91,93 85

352 Small vessel disease, age dependent altera• -- -, systemic immunopathies 270, tions of small intramyocardial vessels 271,272,273,276,277 240,241,245,247 Stereoarteriography 18,19 - -, age distribution of degenerative Substrate delivery in ischemic myocardi• lesions of small intramyocardial vessels um, extraction of glucose 120 245,247 Syndrome X, clinical diagnosis 296 -- -, classification ofintramyocardial -, impaired left ventricular performance arteries 233 during exercise 296,297,298 -- -, clinical diagnosis 257 -, lactate and glucose metabolism 298, - -, coronary hemodynamics 266 299 -- -, disturbances in coronary micro- -, light and electron microscopic observa• circulation 266 tions 283,284,285,296,299,300, -- -, degenerative changes of small 301 papillary muscle-type arteries 237, -, limitation of histologic and angio• 239,240,247 graphic procedures 286,287 - -, degenerative changes of small -, morphology 283,284,285,296,299, compacta-type arteries 236,237,238, 300,301 247 -, myocardial cell alterations 284,286, - -, degenerative types of vascular 296 lesions 233 -- -, etiology of degenerative lesions Tissue/plasma activity ratio (CT/Cp), of small intramyocardial vessels adventitia 6,7,8,9 244,245 - -, media 5, 6 - -, frequency and severity ofvascu• Tracer uptake into the myocardial cell, lar damage 239,240,241 kinetics of thallium exchange 165 -- -, grading of degenerative vascular Xenon residue detection technique, lesions 234 advantages 186 -- -, histopathologic examination -- -, clinical applications 187, 233,251,252 188, 189 -- -, intramyocardial microarterio• - - - , criticisms of the method 182 pathy 231,232 --- -, disadvantages 185 -- -, intramyocardial microarterio• --- -, flow images 186 pathy in diabetes mellitus 242,243, --- -, mathematics 184 246,247 --- -, myocardial blood flow in -- -, intramyocardial microarterio• poststenotic zones 188,189,190 pathy in hypertension 241,242,243, --- -, prerequisites for the applica• 245,247 tion of the Kety-Schmidt method -- -, morphology 231 182,184 -- -, normal anatomy of the small --- -, regional myocardial blood intramural coronary arteries 235 flow after nifedipine 190 -- -, ratio between the severity of --- -, regional myocardial blood extramural coronary artery sclerosis flow after nitroglycerin 190 and type occurrence of intramyocardial --- -, theoretical considerations vascular wall lesions 242,244,246 181 -- -, slow runoff of contrast medium -- -, Xenon-133 washout curve 258,281 180,181, 182, 185

353