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Animal data suggest greater endocardial vulnerability with microvascular impairment; leaves open translation to human perfusion imaging.
Animal experiments using labelled microspheres have shown that at rest, blood flow to the subendocardial layer is higher than to the subepicardium. With increasing levels of stress this transmural gradient of myocardial blood flow is reduced, so that the endocardium has a lower perfusion reserve than the epicardium [ 1 ]. The causes for this observation include higher compressive forces and higher resting metabolic activity in the endocardium. If microvascular function is impaired, endocardial perfusion reserve is reduced further [ 2 ].
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Larghat et al. (2009) studied this question.
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