Coronary back flow pressure is elevated in association with increased left ventricular end-diastolic pressure in humans.

To clarify the effect of left ventricular (LV) diastolic pressure on the coronary pressure-flow relation in humans, the instantaneous diastolic coronary pressure-Doppler flow velocity relation was analyzed at rest and during papaverine-induced maximal vasodilation in 15 patients with angiographically normal coronary arteries. The values for slope (alpha PF) and zero-flow pressure intercept (Pzf index) of the instantaneous diastolic coronary pressure-flow velocity relation were obtained by a linear regression analysis. Although alpha PF did not correlate with LV end-diastolic pressure (EDP), the Pzf index correlated positively with LVEDP both at rest and during maximal vasodilation (r = 0.64, P < 0.05 and r = 0.58, P < 0.05, respectively). Thus, the back pressure to coronary inflow, as indicated by the Pzf index, may be elevated in patients with increased LVEDP, resulting in the rightward shift of the maximally dilated coronary pressure-flow relation and decreased maximal coronary flow and reserve at any given perfusion pressure.