Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease.

Autor:	Cook CM; Imperial College London, London, United Kingdom., Ahmad Y; Imperial College London, London, United Kingdom., Howard JP; Imperial College London, London, United Kingdom., Shun-Shin MJ; Imperial College London, London, United Kingdom., Sethi A; Imperial College London, London, United Kingdom., Clesham GJ; Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom., Tang KH; Essex Cardiothoracic Centre, Basildon, United Kingdom., Nijjer SS; Imperial College London, London, United Kingdom., Kelly PA; Essex Cardiothoracic Centre, Basildon, United Kingdom., Davies JR; Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom., Malik IS; Imperial College London, London, United Kingdom., Kaprielian R; Imperial College London, London, United Kingdom., Mikhail G; Imperial College London, London, United Kingdom., Petraco R; Imperial College London, London, United Kingdom., Al-Janabi F; Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom., Karamasis GV; Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom., Mohdnazri S; Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom., Gamma R; Essex Cardiothoracic Centre, Basildon, United Kingdom., Al-Lamee R; Imperial College London, London, United Kingdom., Keeble TR; Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom., Mayet J; Imperial College London, London, United Kingdom., Sen S; Imperial College London, London, United Kingdom., Francis DP; Imperial College London, London, United Kingdom., Davies JE; Imperial College London, London, United Kingdom. Electronic address: drjustindavies@googlemail.com.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2018 Aug 28; Vol. 72 (9), pp. 970-983.
DOI:	10.1016/j.jacc.2018.06.033
Abstrakt:	Background: Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD). Objectives: The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD. Methods: A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles. Results: PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001). Conclusions: In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics. (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu