Coronary collaterals provide a constant scaffold effect on the left ventricle and limit ischemic left ventricular dysfunction in humans
| Autor: | P White, David P. Dutka, Philip A. Read, Patrick M. Heck, Nick E.J. West, Michael O'Sullivan, Stephen P. Hoole |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Myocardial ischemia Physiology Collateral Circulation Blood Pressure Coronary Angiography Ventricular Dysfunction Left Coronary Circulation Physiology (medical) Internal medicine medicine Humans Angioplasty Balloon Coronary Aged business.industry Coronary Stenosis Hemodynamics Articles Middle Aged Compliance (physiology) medicine.anatomical_structure Coronary Occlusion Ventricle Coronary occlusion Cardiology Female business |
| Zdroj: | Journal of Applied Physiology. 112:1403-1409 |
| ISSN: | 1522-1601 8750-7587 |
| DOI: | 10.1152/japplphysiol.01304.2011 |
| Popis: | Coronary collaterals preserve left ventricular (LV) function during coronary occlusion by reducing myocardial ischemia and may directly influence LV compliance. We aimed to re-evaluate the relationship between coronary collaterals, measured quantitatively with a pressure wire, and simultaneously recorded LV contractility from conductance catheter data during percutaneous coronary intervention (PCI) in humans. Twenty-five patients with normal LV function awaiting PCI were recruited. Pressure-derived collateral flow index (CFI p): CFI p = (P w − P v)/(P a − P v) was calculated from pressure distal to coronary balloon occlusion (P w), central venous pressure (P v), and aortic pressure (P a). CFI p was compared with the changes in simultaneously recorded LV end-diastolic pressure (ΔLVEDP), end-diastolic volume, maximum rate of rise in pressure (ΔLVdP/dtmax; systolic function), and time constant of isovolumic relaxation (ΔLV τ; diastolic function), measured by a LV cavity conductance catheter. Measurements were recorded at baseline and following a 1-min coronary occlusion and were duplicated after a 30-min recovery period. There was significant LV diastolic dysfunction following coronary occlusion (ΔLVEDP: +24.5%, P < 0.0001; and ΔLV τ: +20.0%, P < 0.0001), which inversely correlated with CFI p (ΔLVEDP vs. CFI p: r = −0.54, P < 0.0001; ΔLV τ vs. CFI p: r = −0.46, P = 0.0009). Subjects with fewer collaterals had lower LVEDP at baseline (r = 0.33, P = 0.02). CFI p was inversely related to the coronary stenosis pressure gradient at rest (r = −0.31, P = 0.03). Collaterals exert a direct hemodynamic effect on the ventricle and attenuate ischemic LV diastolic dysfunction during coronary occlusion. Vessels with lesions of greater hemodynamic significance have better collateral supply. |
| Databáze: | OpenAIRE |
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