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(Circulation. 2005;111:2165-2170.)
© 2005 American Heart Association, Inc.

Coronary Heart Disease

Effects of High Thoracic Epidural Analgesia on Myocardial Blood Flow in Patients With Ischemic Heart Disease

Eigil Nygård, MD; Klaus F. Kofoed, MD, DMSc; Jacob Freiberg, MD, BS; Søren Holm, PhD; Jan Aldershvile, MD, DMSc; Kirsten Eliasen, MD; Henning Kelbæk, MD, DMSc

From the Departments of Cardio-thoracic Anesthesia (E.N., K.E.), Cardiology (K.F.K., J.F., J.A., H.K.), and Nuclear Medicine (S.H.), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Correspondence to Klaus F. Kofoed, MD, DMSc, Department of Cardiology B, Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail kkofoed{at}dadlnet.dk

Received August 16, 2004; revision received January 10, 2005; accepted January 13, 2005.

Background— In patients with ischemic heart disease, high thoracic epidural analgesia (TEA) has been proposed to improve abnormalities of coronary function by inhibiting cardiac sympathetic tone. We evaluated the effect of TEA on myocardial blood flow in patients with ischemic heart disease.

Methods and Results— Twenty male patients with multivessel ischemic heart disease were studied. An epidural catheter was inserted between the second and third thoracic vertebral interspace (Th2 to Th3). Analgesia was induced by epidural injection of bupivacaine 0.5%, and a sensory block from the sixth cervical (C6 to C7) to Th10 (Th8 to Th11) vertebral interspace was achieved. Myocardial blood flow was measured with dynamic ¹³N-ammonia PET with and without TEA at rest, during pharmacological vasodilation with dipyridamole, and during sympathetic stimulation with the cold pressor test. Myocardial blood flow during dipyridamole increased similarly, regardless of TEA, in all regions except in myocardium subtended by collateral arteries in which blood flow increased more with than without TEA (P<0.05). Without TEA, myocardial blood flow during the cold pressor test remained unchanged compared with myocardial blood flow at rest. In contrast, with TEA, myocardial blood flow increased in all vascular territories. Coronary vascular resistance increased during the cold pressor test without TEA, whereas with TEA, coronary resistance decreased in myocardium subtended by nonstenotic and stenotic coronary vessels and remained unchanged in myocardium subtended by occluded vessels.

Conclusions— In patients with multivessel ischemic heart disease, TEA partly normalizes the myocardial blood flow response to sympathetic stimulation.

Key Words: blood flow, myocardial • ischemia, myocardial • analgesia, epidural

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