(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
This article has been cited by other articles:
 |
|
 |
|
  V. R. S. Fernandes, J. F. Polak, S. Cheng, B. D. Rosen, B. Carvalho, K. Nasir, R. McClelland, G. Hundley, G. Pearson, D. H. O'Leary, et al. Arterial Stiffness Is Associated With Regional Ventricular Systolic and Diastolic Dysfunction: The Multi-Ethnic Study of Atherosclerosis Arterioscler. Thromb. Vasc. Biol., January 1, 2008; 28(1): 194 - 201. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Jegger, R. F. da Silva, I. Lartaud, V. Gaillard, X. Jeanrenaud, M. Nasratullah, L. K. von Segesser, J. Atkinson, P. Segers, H. Tevaearai, et al. Effects of an aging vascular model on healthy and diseased hearts Am J Physiol Heart Circ Physiol, September 1, 2007; 293(3): H1334 - H1343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Mullick, U. B. Zaid, C. N. Athanassious, S. R. Lentz, J. C. Rutledge, and J. D. Symons Hyperhomocysteinemia increases arterial permeability and stiffness in mice Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2006; 291(5): R1349 - R1354. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D Fukuda, M Yoshiyama, K Shimada, H Yamashita, S Ehara, Y Nakamura, K Kamimori, A Tanaka, T Kawarabayashi, and J Yoshikawa Relation between aortic stiffness and coronary flow reserve in patients with coronary artery disease Heart, June 1, 2006; 92(6): 759 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Edwards, A. L. Gauthier, M. A. Hayman, J. T. Lang, and R. W. Kenefick Acute effects of cold exposure on central aortic wave reflection J Appl Physiol, April 1, 2006; 100(4): 1210 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Symons, U. B. Zaid, C. N. Athanassious, A. E. Mullick, S. R. Lentz, and J. C. Rutledge Influence of Folate on Arterial Permeability and Stiffness in the Absence or Presence of Hyperhomocysteinemia Arterioscler. Thromb. Vasc. Biol., April 1, 2006; 26(4): 814 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B A Haluska, K Matthys, R Fathi, E Rozis, S G Carlier, and T H Marwick Influence of arterial compliance on presence and extent of ischaemia during stress echocardiography Heart, January 1, 2006; 92(1): 40 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Saha and A. D Timmis Review: Diabetic autonomic dysfunction: adverse effects on presentation, management and outcomes of acute coronary syndromes The British Journal of Diabetes & Vascular Disease, September 1, 2005; 5(5): 260 - 264. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Williams, B. A Kingwell, K. Burke, J. McPherson, and A. M Dart Folic acid supplementation for 3 wk reduces pulse pressure and large artery stiffness independent of MTHFR genotype Am. J. Clinical Nutrition, July 1, 2005; 82(1): 26 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Kass Ventricular Arterial Stiffening: Integrating the Pathophysiology Hypertension, July 1, 2005; 46(1): 185 - 193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Barbato, Q.-Q. Huang, M. M. Hossain, M. Bond, and J.-P. Jin Proteolytic N-terminal Truncation of Cardiac Troponin I Enhances Ventricular Diastolic Function J. Biol. Chem., February 25, 2005; 280(8): 6602 - 6609. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. L. Medley, T. J. Cole, A. M. Dart, C. D. Gatzka, and B. A. Kingwell Matrix Metalloproteinase-9 Genotype Influences Large Artery Stiffness Through Effects on Aortic Gene and Protein Expression Arterioscler. Thromb. Vasc. Biol., August 1, 2004; 24(8): 1479 - 1484. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Cameron, C. J. Bulpitt, E. S. Pinto, and C. Rajkumar The Aging of Elastic and Muscular Arteries: A comparison of diabetic and nondiabetic subjects Diabetes Care, July 1, 2003; 26(7): 2133 - 2138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Houser and K. B. Margulies Is Depressed Myocyte Contractility Centrally Involved in Heart Failure? Circ. Res., March 7, 2003; 92(4): 350 - 358. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Mekkaoui, P. H. Rolland, A. Friggi, M. Rasigni, and T. G. Mesana Pressure-flow loops and instantaneous input impedance in the thoracic aorta: Another way to assess the effect of aortic bypass graft implantation on myocardial, brain, and subdiaphragmatic perfusion J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 699 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. W. Haider, M. G. Larson, S. S. Franklin, and D. Levy Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Pressure as Predictors of Risk for Congestive Heart Failure in the Framingham Heart Study Ann Intern Med, January 7, 2003; 138(1): 10 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Kingwell, T. K. Waddell, T. L. Medley, J. D. Cameron, and A. M. Dart Large artery stiffness predicts ischemic threshold in patients with coronary artery disease J. Am. Coll. Cardiol., August 21, 2002; 40(4): 773 - 779. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Symons, A. E. Mullick, J. L. Ensunsa, A. A. Ma, and J. C. Rutledge Hyperhomocysteinemia Evoked by Folate Depletion: Effects on Coronary and Carotid Arterial Function Arterioscler. Thromb. Vasc. Biol., May 1, 2002; 22(5): 772 - 780. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. E. Ferrier, M. H. Muhlmann, J.-P. Baguet, J. D. Cameron, G. L. Jennings, A. M. Dart, and B. A. Kingwell Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertension J. Am. Coll. Cardiol., March 20, 2002; 39(6): 1020 - 1025. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Abramson, W. S. Weintraub, and V. Vaccarino Association Between Pulse Pressure and C-Reactive Protein Among Apparently Healthy US Adults Hypertension, February 1, 2002; 39(2): 197 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Domanski, J. Norman, M. Wolz, G. Mitchell, and M. Pfeffer Cardiovascular Risk Assessment Using Pulse Pressure in the First National Health and Nutrition Examination Survey (NHANES I) Hypertension, October 1, 2001; 38(4): 793 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. E. Ferrier, T. K. Waddell, C. D. Gatzka, J. D. Cameron, A. M. Dart, and B. A. Kingwell Aerobic Exercise Training Does Not Modify Large-Artery Compliance in Isolated Systolic Hypertension Hypertension, August 1, 2001; 38(2): 222 - 226. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Dart and B. A. Kingwell Pulse pressure--a review of mechanisms and clinical relevance J. Am. Coll. Cardiol., March 15, 2001; 37(4): 975 - 984. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. W. Nichols and D. G. Edwards Arterial Elastance and Wave Reflection Augmentation of Systolic Blood Pressure: Deleterious Effects and Implications for Therapy Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2001; 6(1): 5 - 21. [Abstract] [PDF]
|
|
|
|
 |
|
 R. J. Glynn, C. U. Chae, J. M. Guralnik, J. O. Taylor, and C. H. Hennekens Pulse Pressure and Mortality in Older People Arch Intern Med, October 9, 2000; 160(18): 2765 - 2772. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. H. Rolland, A.-B. Charifi, C. Verrier, H. Bodard, A. Friggi, P. Piquet, G. Moulin, and J.-M. Bartoli Hemodynamics and Wall Mechanics after Stent Placement in Swine Iliac Arteries: Comparative Results from Six Stent Designs Radiology, October 1, 1999; 213(1): 229 - 246. [Abstract] [Full Text]
|
|
|
|
|
|
D. A. Bertovic, T. K. Waddell, C. D. Gatzka, J. D. Cameron, A. M. Dart, and B. A. Kingwell Muscular Strength Training Is Associated With Low Arterial Compliance and High Pulse Pressure Hypertension, June 1, 1999; 33(6): 1385 - 1391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. U. Chae, M. A. Pfeffer, R. J. Glynn, G. F. Mitchell, J. O. Taylor, and C. H. Hennekens Increased Pulse Pressure and Risk of Heart Failure in the Elderly JAMA, February 17, 1999; 281(7): 634 - 643. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Gatzka, J. D. Cameron, B. A. Kingwell, and A. M. Dart Relation Between Coronary Artery Disease, Aortic Stiffness, and Left Ventricular Structure in a Population Sample Hypertension, September 1, 1998; 32(3): 575 - 578. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. F. Mitchell, L. A. Moye, E. Braunwald, J.-L. Rouleau, V. Bernstein, E. M. Geltman, G. C. Flaker, M. A. Pfeffer, and f. t. S. Investigators Sphygmomanometrically Determined Pulse Pressure Is a Powerful Independent Predictor of Recurrent Events After Myocardial Infarction in Patients With Impaired Left Ventricular Function Circulation, December 16, 1997; 96(12): 4254 - 4260. [Abstract] [Full Text]
|
|
|
|
|
|
B. A. Kingwell, K. L. Berry, J. D. Cameron, G. L. Jennings, and A. M. Dart Arterial compliance increases after moderate-intensity cycling Am J Physiol Heart Circ Physiol, November 1, 1997; 273(5): H2186 - H2191. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A Kingwell, P. J Arnold, G. L Jennings, and A. M Dart Spontaneous running increases aortic compliance in Wistar-Kyoto rats Cardiovasc Res, July 1, 1997; 35(1): 132 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. L. Medley, T. J. Cole, C. D. Gatzka, W. Y.S. Wang, A. M. Dart, and B. A. Kingwell Fibrillin-1 Genotype Is Associated With Aortic Stiffness and Disease Severity in Patients With Coronary Artery Disease Circulation, February 19, 2002; 105(7): 810 - 815. [Abstract] [Full Text] [PDF]
|
|