Circulation, Vol 88, 461-471, Copyright © 1993 by American Heart Association
B De Bruyne, JG Bronzwaer, GR Heyndrickx and WJ Paulus
BACKGROUND. During the initial phase of an ischemic insult, left
ventricular (LV) performance depends on the complex interaction between
oxygen deprivation, vascular turgor, and accumulation of metabolites. In
experimental preparations, low-flow ischemia decreases systolic shortening
and increases diastolic LV distensibility, whereas pacing- induced ischemia
or hypoxic perfusion produces smaller decreases in systolic shortening but
decreases LV diastolic distensibility. The purpose of this study was to
investigate the different effects of low- flow ischemia, pacing-induced
ischemia, and hypoxemic perfusion on LV performance in humans. METHODS AND
RESULTS. In 20 patients with a significant stenosis in the left anterior
descending coronary artery, micromanometer-tip LV pressure recordings (n =
20), LV angiography (n = 18), and coronary sinus blood sampling (n = 11)
were obtained at rest and during the following conditions: pacing-induced
ischemia (PI) (n = 11), low-flow ischemia of balloon coronary occlusion
(CO) (n = 20), and hypoxemia induced by balloon coronary occlusion with
hypoxemic perfusion distal to the occlusion (CO+P) (n = 11). LV stroke work
index fell from 75 +/- 17 g.m at rest to 43 +/- 14 g.m at the end of CO (n
= 18; P < .001). In addition, LV stroke work index was lower at the end
of CO than during PI (50 +/- 11 vs 77 +/- 15 g.m; n = 11; P < .002) and
was lower at the end of CO than at the end of CO+P (35 +/- 7 vs 46 +/- 9
g.m; n = 9; P < .02). LV end-diastolic pressure rose from 16 +/- 5 mm Hg
at rest to 23 +/- 6 mm Hg at the end of CO (n = 20; P < .001). However,
LV end-diastolic pressure was lower at the end of CO than during PI (20 +/-
5 vs 30 +/- 5 mm Hg; n = 11; P < .002) and was lower at the end of CO
than at the end of CO+P (26 +/- 5 vs 34 +/- 7 mm Hg; n = 11; P < .01).
LV end-diastolic volume index increased from 75 +/- 14 mL/m2 at rest to 79
+/- 15 mL/m2 at the end of CO (n = 18; P < .05). Left ventricular
end-diastolic volume index increased to values similar to those for CO
during PI (79 +/- 13 mL/m2; n = 11; P = NS) and at the end of CO+P (78 +/-
14 mL/m2; n = 9; P = NS). Higher values of LV end- diastolic pressure and
unchanged values of LV end-diastolic volume index for PI and CO+P, compared
with CO, suggested a lower end- diastolic LV distensibility during PI and
during hypoxemia, as compared with low-flow ischemia. Upward shifts of
individual diastolic LV pressure-volume curves during PI (9 of 11 patients)
and at the end of CO+P (7 of 9 patients), compared with CO, were also
consistent with lower LV diastolic distensibility during pacing-induced
ischemia and during hypoxemia, compared with low-flow ischemia. Coronary
sinus lactate, H+, and K+ levels increased after balloon deflation (CO and
CO+P) and during pacing (PI). CONCLUSIONS. Thus, during low-flow ischemia,
LV systolic performance was lower and LV diastolic distensibility larger
than during pacing-induced ischemia or hypoxemia. The variable response of
the human myocardium to different types of ischemia was probably related to
the degree of vascular turgor and accumulation of tissue metabolites.
ARTICLES
Comparative effects of ischemia and hypoxemia on left ventricular systolic and diastolic function in humans
Cardiovascular Center, Aalst, Belgium.
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