Coronary artery blood flow in humans
File(s)
Author(s)
Seligman, Henry
Type
Thesis or dissertation
Abstract
Coronary artery disease remains the single largest cause of death in both developed
and developing nations. Despite a large amount of study, the flow of blood in the
coronary circulation is imperfectly understood. The feedback between the demand for
blood in the myocardium and the supply of blood from the ventricular cavity via the
aortocoronary vessels, is unique in the human cardiovascular system. Adequate
coronary blood supply is essential to meet the metabolic demands of the myocardial
tissue and in turn to maintain cardiac output. Diseases of the body's many systems
appear to impact coronary blood flow which may have downstream effects on heart
function, health, and longevity. The constraints of clinical investigation determine, in
part, how we can investigate these systems in humans.
In this thesis I explore some unanswered questions about coronary physiology. First,
I question previously held beliefs about variation in blood flow across the phases of
the cardiac cycle and between different coronary territories using data from clinical
studies of epicardial coronary artery stenosis in patients being investigated for chest
pain. I then go on to investigate whether the measurement of coronary blood flow
itself can be improved using image processing techniques which rely on machine
learning. I then explore the impact of ventricular tachycardia on regulation of
coronary blood flow. Finally, I look at the links between overall health status and the
health of the coronary circulation, at a study-level, in two separate systematic review
and meta-analysis studies.
and developing nations. Despite a large amount of study, the flow of blood in the
coronary circulation is imperfectly understood. The feedback between the demand for
blood in the myocardium and the supply of blood from the ventricular cavity via the
aortocoronary vessels, is unique in the human cardiovascular system. Adequate
coronary blood supply is essential to meet the metabolic demands of the myocardial
tissue and in turn to maintain cardiac output. Diseases of the body's many systems
appear to impact coronary blood flow which may have downstream effects on heart
function, health, and longevity. The constraints of clinical investigation determine, in
part, how we can investigate these systems in humans.
In this thesis I explore some unanswered questions about coronary physiology. First,
I question previously held beliefs about variation in blood flow across the phases of
the cardiac cycle and between different coronary territories using data from clinical
studies of epicardial coronary artery stenosis in patients being investigated for chest
pain. I then go on to investigate whether the measurement of coronary blood flow
itself can be improved using image processing techniques which rely on machine
learning. I then explore the impact of ventricular tachycardia on regulation of
coronary blood flow. Finally, I look at the links between overall health status and the
health of the coronary circulation, at a study-level, in two separate systematic review
and meta-analysis studies.
Version
Open Access
Date Issued
2023-09-13
Date Awarded
2026-06-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Francis, Darrel
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)