Small Vessel Phenomena in the Coronary Microcirculation: Phasic Intramyocardial Perfusion and Coronary Microvascular Dynamics

To place the characteristics of the coronary microcirculation in perspective to another muscular organ system, we have compared various parameters from exchange vessels in the heart and red skeletal muscle. The major differences between cardiac and skeletal muscle microcirculations relate to the larger density of capillaries in the heart. This increased density is responsible primarily for a greater capillary filtration coefficient-permeability-surface area product to various solutes, surface area, and decreased intercapillary distances. These features most likely represent an adaptation of the microcirculation of the heart to the very high, continual metabolic demands. Interestingly, capillary permeabilities and reflection coefficients of different solutes are in the same range (although the heart tends to have higher capillary permeabilities). Thus, the adaptation of the coronary circulation to facilitate exchange of nutrients and solutes is mediated via an increase in the numbers of exchange vessels, rather than modifications of the membrane characteristics of these exchange vessels. Within the last decade, there has been much information assimilated on the regulation of the coronary microcirculation. Most of the knowledge has been the result of many indirect approaches to studying the coronary microcirculation (indicator-dilution techniques, nuclide-labeled microspheres, plasma-lymph concentration of solutes). There are relatively few direct observations on regulation of the coronary microcirculation. This is primarily due to difficulties in techniques. Exploration of the phasic nature of intramyocardial perfusion is handicapped by the location of these intramuscular vessels. Visualization of the coronary microcirculation is hampered by movements of the heart, and such measurements are restricted to the superficial layers of the myocardium. It is worth emphasizing that direct observations of red cell velocities in epicardial capillaries, measurements of microvascular caliber, and the pressure profiles in the coronary microcirculation are restricted to the superficial, epicardial layer. It is not unreasonable to speculate that microvascular events and regulation occurring in the subepicardium may be quite different than that in the subendocardium. There are several salient points in this review that are worth emphasizing.(ABSTRACT TRUNCATED AT 400 WORDS)