(Circulation. 2001;103:2352.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Paradoxical Increase in Microvascular Resistance During Tachycardia Downstream From a Severe Stenosis in Patients With Coronary Artery Disease
Reversal by Angioplasty
From the CNR Institute of Clinical Physiology, Pisa, and the Cardiothoracic Department, University of Pisa (M.M.), Italy.
Correspondence to Gianmario Sambuceti, MD, CNR Institute of Clinical Physiology, Via P. Savi, 8, 56100, Pisa, Italy. E-mail battesto{at}po.ifc.pi.cnr.it
Background—The pathophysiology of microvascular response to a severe coronary stenosis has not been conclusively identified. The aim of this study was to characterize the human vasomotor response to pacing-induced ischemia of both the stenotic arterial segment and the distal microcirculation.
Methods and Results—Sixteen patients with stable angina and single-vessel disease were studied. Blood flow velocity and transstenotic pressure gradient were monitored at baseline, after intracoronary adenosine (2 mg), and during ischemia induced by atrial pacing with and without adenosine. At the end of this protocol, the study was repeated after intracoronary phentolamine in 7 patients and after angioplasty in 9. Stenosis resistance was calculated as the ratio between mean pressure gradient and mean flow, and microvascular resistance as the ratio between mean distal pressure and mean flow; values were expressed as percent of baseline. Adenosine decreased (P<0.05) baseline microvascular resistance to 52±17%, but not stenosis resistance. Pacing increased both stenosis and microvascular resistances (244±96% and 164±60% of baseline, respectively, P<0.05). Addition of adenosine to pacing decreased both stenosis (143±96% of baseline, P<0.05 versus ischemia) and microvascular (51±17% of baseline, P<0.05 versus baseline and ischemia) resistances. Phentolamine did not affect coronary resistance at any step of the protocol. Angioplasty and stenting restored a progressive decline in microvascular resistance during pacing (51±19% of baseline, P<0.05 versus baseline).
Conclusions—In patients with coronary artery disease, tachycardia-induced ischemia was associated with elevated resistance of both the stenotic segment and the microvasculature. Revascularization prevents this paradoxical behavior.
Key Words: coronary disease • circulation • blood flow • microcirculation • vasoconstriction
This article has been cited by other articles:
 |
|
 |
|
  G. Landesberg, W. S. Beattie, M. Mosseri, A. S. Jaffe, and J. S. Alpert Perioperative Myocardial Infarction Circulation, June 9, 2009; 119(22): 2936 - 2944. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Brugaletta, V. Martin Yuste, and M. Sabate Letter by Brugaletta et al Regarding Article, "Interference of Drug-Eluting Stents and Endothelium-Dependent Coronary Vasomotion: Evidence for Device-Specific Responses" Circ Cardiovasc Interv, April 1, 2009; 2(2): e1 - e1. [Full Text] [PDF]
|
|
|
|
|
|
M. Hamilos, J. Sarma, and W. Wijns Response to Letter Regarding Article, "Interference of Drug-Eluting Stents and Endothelium-Dependent Coronary Vasomotion: Evidence for Device-Specific Responses" Circ Cardiovasc Interv, April 1, 2009; 2(2): e2 - e2. [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Pries, H. Habazettl, G. Ambrosio, P. R. Hansen, J. C. Kaski, V. Schachinger, H. Tillmanns, G. Vassalli, I. Tritto, M. Weis, et al. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings Cardiovasc Res, November 1, 2008; 80(2): 165 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Sorop, D. Merkus, V. J. de Beer, B. Houweling, A. Pistea, E. O. McFalls, F. Boomsma, H. M. van Beusekom, W. J. van der Giessen, E. VanBavel, et al. Functional and Structural Adaptations of Coronary Microvessels Distal to a Chronic Coronary Artery Stenosis Circ. Res., April 11, 2008; 102(7): 795 - 803. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Marques, P. Knaapen, R. Boellaard, N. Westerhof, A. A. Lammertsma, C. A. Visser, and F. C. Visser Hyperaemic microvascular resistance is not increased in viable myocardium after chronic myocardial infarction Eur. Heart J., October 1, 2007; 28(19): 2320 - 2325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. H. J. Pijls Fractional flow reserve after previous myocardial infarction Eur. Heart J., October 1, 2007; 28(19): 2301 - 2302. [Full Text] [PDF]
|
|
|
|
 |
|
 H. J. Verberne, M. Meuwissen, S. A. J. Chamuleau, B.-J. Verhoeff, B. L. F. van Eck-Smit, J. A. E. Spaan, J. J. Piek, and M. Siebes Effect of simultaneous intracoronary guidewires on the predictive accuracy of functional parameters of coronary lesion severity Am J Physiol Heart Circ Physiol, May 1, 2007; 292(5): H2349 - H2355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kusmic, G. Lazzerini, F. Coceani, R. Barsacchi, A. L'Abbate, and G. Sambuceti Paradoxical coronary microcirculatory constriction during ischemia: a synergic function for nitric oxide and endothelin Am J Physiol Heart Circ Physiol, October 1, 2006; 291(4): H1814 - H1821. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K.C. Ng, A. C. Yeung, and W. F. Fearon Invasive Assessment of the Coronary Microcirculation: Superior Reproducibility and Less Hemodynamic Dependence of Index of Microcirculatory Resistance Compared With Coronary Flow Reserve Circulation, May 2, 2006; 113(17): 2054 - 2061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Tomai, F. Ribichini, A. S. Ghini, V. Ferrero, G. Ando, C. Vassanelli, F. Romeo, F. Crea, and L. Chiariello Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease Eur. Heart J., October 2, 2005; 26(20): 2099 - 2105. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Sambuceti, M. Marzilli, A. Mari, C. Marini, M. Schluter, R. Testa, M. Papini, P. Marraccini, G. Ciriello, P. Marzullo, et al. Coronary microcirculatory vasoconstriction is heterogeneously distributed in acutely ischemic myocardium Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2298 - H2305. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.-J. Verhoeff, M. Siebes, M. Meuwissen, B. Atasever, M. Voskuil, R. J. de Winter, K. T. Koch, J. G.P. Tijssen, J. A.E. Spaan, and J. J. Piek Influence of Percutaneous Coronary Intervention on Coronary Microvascular Resistance Index Circulation, January 4, 2005; 111(1): 76 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Aarnoudse, W. F. Fearon, G. Manoharan, M. Geven, F. van de Vosse, M. Rutten, B. De Bruyne, and N. H.J. Pijls Epicardial Stenosis Severity Does Not Affect Minimal Microcirculatory Resistance Circulation, October 12, 2004; 110(15): 2137 - 2142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. F. Fearon, W. Aarnoudse, N. H.J. Pijls, B. De Bruyne, L. B. Balsam, D. T. Cooke, R. C. Robbins, P. J. Fitzgerald, A. C. Yeung, and P. G. Yock Microvascular Resistance Is Not Influenced by Epicardial Coronary Artery Stenosis Severity: Experimental Validation Circulation, May 18, 2004; 109(19): 2269 - 2272. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Siebes, B.-J. Verhoeff, M. Meuwissen, R. J. de Winter, J. A.E. Spaan, and J. J. Piek Single-Wire Pressure and Flow Velocity Measurement to Quantify Coronary Stenosis Hemodynamics and Effects of Percutaneous Interventions Circulation, February 17, 2004; 109(6): 756 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. J. Chamuleau, M. Siebes, M. Meuwissen, K. T. Koch, J. A. E. Spaan, and J. J. Piek Association between coronary lesion severity and distal microvascular resistance in patients with coronary artery disease Am J Physiol Heart Circ Physiol, November 1, 2003; 285(5): H2194 - H2200. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Marzilli, G. Sambuceti, R. Testa, and S. Fedele Platelet glycoprotein IIb/IIIa receptor blockade and coronary resistance in unstable angina J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2102 - 2109. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Siebes, S. A. J. Chamuleau, M. Meuwissen, J. J. Piek, and J. A. E. Spaan Influence of hemodynamic conditions on fractional flow reserve: parametric analysis of underlying model Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1462 - H1470. [Abstract] [Full Text] [PDF]
|
|