Coronary Perfusion Pressure Calculation

Formula and Components

Coronary perfusion pressure equals aortic diastolic pressure minus left ventricular end-diastolic pressure (LVEDP), as recommended by the American Heart Association 1
Coronary perfusion pressure can be calculated as aortic diastolic pressure minus right atrial diastolic pressure, particularly during cardiopulmonary resuscitation when simultaneous aortic and central venous pressure monitoring is available, according to the American College of Cardiology 2, 3

Myocardial perfusion occurs predominantly during diastole, making diastolic blood pressure the primary determinant of coronary perfusion pressure, as stated by the American Heart Association 1
The pressure gradient between the aorta and left ventricle during diastole drives coronary blood flow, as reported by the American College of Cardiology 1

A coronary perfusion pressure threshold of 15 mm Hg during CPR is required for return of spontaneous circulation (ROSC), as recommended by the American Heart Association 2, 3
During CPR, aortic relaxation diastolic pressure must exceed 17 mm Hg for ROSC to occur, according to the American College of Cardiology 2, 3

Right ventricular coronary perfusion differs from left ventricular perfusion, as RV perfusion occurs during both systole and diastole, unlike the predominantly diastolic LV coronary flow, as reported by the American College of Cardiology 4
In pressure-overloaded right ventricles, decreased perfusion pressure combined with increased RV intramural pressure increases ischemia risk, as stated by the American Heart Association 4
Central venous pressure can be substituted for LVEDP when measuring CPP during resuscitation, as simultaneous aortic and LV pressure measurement is rarely clinically available, according to the American College of Cardiology 2, 3

Myocardial perfusion occurs almost exclusively during diastole, making diastolic blood pressure the primary coronary perfusion pressure 5
Coronary perfusion pressure equals aortic diastolic pressure minus left ventricular diastolic pressure or central venous pressure 5
In normal coronary arteries, aortic pressure is transmitted completely without appreciable pressure loss even to distal regions 6

This autoregulatory capacity has limits - at the point of maximal vasodilation, further falls in perfusion pressure will result in decreased coronary flow 5
Coronary flow reserve is markedly impaired in the presence of left ventricular hypertrophy 5
Coronary flow reserve is markedly impaired in the presence of coronary atherosclerosis and/or microangiopathy 5

In elderly patients with isolated systolic hypertension, the wide pulse pressure is due to increased aortic stiffness 7
Increased arterial stiffness leads to decreased diastolic blood pressure (potentially compromising coronary perfusion) 7
High systolic pressure increases myocardial oxygen demand 7