(Circulation. 1996;93:1533-1541.)
© 1996 American Heart Association, Inc.
Articles |
Adverse Influence of Systemic Vascular Stiffening on Cardiac Dysfunction and Adaptation to Acute Coronary Occlusion
From the Division of Cardiology, Department of Internal Medicine, and the Department of Biomedical Engineering, the Johns Hopkins Medical Institutions, Baltimore, Md.
Correspondence to David A. Kass, MD, Halsted 500, Division of Cardiology, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287.
Background Age is an independent risk factor for increased mortality from ischemic heart disease. Arterial stiffening with widening of the pulse pressure may contribute to this risk by exacerbating cardiac dysfunction after total coronary artery occlusion.
Methods and Results To test the above hypothesis, 14
open-chest dogs underwent surgery in which the intrathoracic aorta
was bypassed with a stiff plastic tube. Directing
ventricular outflow through the bypass widened the
arterial pulse pressure from 41 to 115 mm Hg at similar
mean pressure and flow. Hearts ejecting into the native aorta (NA)
exhibited only modest dysfunction after 2 minutes of mid–left
anterior descending coronary artery occlusion. However, the
same occlusion applied during ejection into the bypass tube (BT)
induced far more severe cardiodepression (ie, systolic pressure
fell by -41±10 mm Hg for BT versus -15±3 mm Hg for NA, and
end-systolic volume rose by 15±3 versus 6±2 mL), with a
threefold greater decline in ejection fraction. This disparity was not
due to higher baseline work loads because total pressure-volume
area was similar in both cases. Furthermore, marked increases in basal
work load and wall stress induced by angiotensin II
infusion (in four additional studies) did not reproduce this behavior.
Although peak systolic chamber stress was greater with the BT,
this did not increase systolic dyskinesis as measured in the
central ischemic zone. However, the total mass of
myocardium that was rendered severely ischemic (ie,
flow reduced by 
80%) was twice as large with BT ejection, likely
expanding the region of dyskinesis. This disparity may relate to
altered phasic coronary flow during BT ejection, which displays
marked enhancement of systolic flow and renders the heart more
vulnerable to diminished mean and systolic perfusion
pressures.
Conclusions Cardiac ejection into a stiff systemic vasculature augments cardiac dysfunction and ischemia due to coronary occlusion by tightening the link between cardiac systolic performance and myocardial perfusion. This may contribute to the higher mortality risk from ischemic heart disease due to age.
Key Words: aging • blood pressure • ischemia • regional blood flow • risk factor
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