Cited by 936Cardiovascular and exercise physiologyCardiac Imaging and DiagnosticsNitric Oxide and Endothelin Effects

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Regulation of Coronary Blood Flow During Exercise

Duncker, Dirk J., Bache, Robert J.·2008·Physiological Reviews

DOI 10.1152/physrev.00045.2006

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Abstract

Exercise is the most important physiological stimulus for increased myocardial oxygen demand. The requirement of exercising muscle for increased blood flow necessitates an increase in cardiac output that results in increases in the three main determinants of myocardial oxygen demand: heart rate, myocardial contractility, and ventricular work. The approximately sixfold increase in oxygen demands of the left ventricle during heavy exercise is met principally by augmenting coronary blood flow (~5-fold), as hemoglobin concentration and oxygen extraction (which is already 70-80% at rest) increase only modestly in most species. In contrast, in the right ventricle, oxygen extraction is lower at rest and increases substantially during exercise, similar to skeletal muscle, suggesting fundamental differences in blood flow regulation between these two cardiac chambers. The increase in heart rate also increases the relative time spent in systole, thereby increasing the net extravascular compressive forces acting on the microvasculature within the wall of the left ventricle, in particular in its subendocardial layers. Hence, appropriate adjustment of coronary vascular resistance is critical for the cardiac response to exercise. Coronary resistance vessel tone results from the culmination of myriad vasodilator and vasoconstrictors influences, including neurohormones and endothelial and myocardial factors. Unraveling of the integrative mechanisms controlling coronary vasodilation in respons…

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Authors: Duncker, D. J., & Bache, R. J.
Affiliations: Erasmus MC (NL)
ORCID: Duncker, Dirk J.
Bache, Robert J.
Venue: Physiological Reviews
Publisher: American Physiological Society
Published: 2008-07
Volume: 88
Issue: 3
Pages: 1009-1086
ISSN: 0031-9333 (ISSN-L)
1522-1210
DOI: 10.1152/physrev.00045.2006
OpenAlex: W2134256354
Cited by: 936
References: 646
Citations by year: 2026: 44 · 2025: 49 · 2024: 50 · 2023: 53 · 2022: 55 · 2021: 69 · 2020: 40 · 2019: 45 · 2018: 57 · 2017: 61 · 2016: 36 · 2015: 50 · 2014: 48 · 2013: 66 · 2012: 60
FWCI: 8.93
Type: journal article
Language: en
Open access: closed
Locations: Physiological Reviews (publishedVersion)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
Keywords: coronary blood flow, physical activity, myocardial oxygen demand, coronary vasodilation, coronary microcirculation, exercise training, capillary density, adrenergic tone, nitric oxide synthase, endothelium-dependent vasodilation, myogenic tone, protein kinase C, nitric oxide, cardiac output, coronary vascular resistance
MeSH terms: Adaptation, Physiological, Animals, Collateral Circulation, Coronary Circulation, Hemodynamics, Humans, Models, Cardiovascular, Oxygen Consumption, Exercise, Ventricular Function, Coronary Stenosis

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Regulation of Coronary Blood Flow During Exercise

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