Modulation of left ventricular diastolic distensibility by collateral flow recruitment during balloon coronary occlusion
OBJECTIVES The goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of recruited collateral flow in modulating left ventricular (LV) distensibility during balloon coronary occlusion (BCO). BACKGROUND Although LV disten...
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Published in | Journal of the American College of Cardiology Vol. 34; no. 2; pp. 500 - 506 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Elsevier Inc
01.08.1999
Elsevier Science |
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Abstract | OBJECTIVES
The goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of recruited collateral flow in modulating left ventricular (LV) distensibility during balloon coronary occlusion (BCO).
BACKGROUND
Although LV distensibility is an important factor affecting acute dilation after myocardial infarction, the response of LV diastolic pressure–volume (P-V) relations to coronary occlusion is inconsistent in humans.
METHODS
Micromanometer and conductance derived LV P-V loops were serially obtained from 16 patients undergoing percutaneous transluminal coronary angioplasty. Coronary collateral flow recruitment was angiographically evaluated by contralateral and ipsilateral contrast injection during BCO.
RESULTS
In the group with poor collateral flow (grades 0–I; n = 8), BCO resulted in a downward and rightward shift of the diastolic P-V relations, where end-diastolic volume (EDV) increased by 13% (p < 0.05) without appreciable change in end-diastolic pressure (EDP; 18 ± 6 to 18 ± 8 mm Hg). In contrast, BCO in the group with good collateral flow (grades II–III; n = 8) shifted the diastolic P-V relations upward to the right with a concomitant increase in minimal pressure (min-P; 6 ± 4 to 10 ± 5 mm Hg, p < 0.05), EDP (15 ± 7 to 21 ± 9 mm Hg, p < 0.05) and EDV (+10%, p < 0.05). Reactive hyperemia after balloon deflation caused a rapid and parallel upward shift of the diastolic P-V relations with a marked increase in min-P and EDP, especially in the group with poor collateral flow, before any improvement in LV contraction or relaxation abnormalities.
CONCLUSIONS
Grades of coronary filling, either retrograde or anterograde, abruptly modulate LV distensibility through the rapid scaffolding effect of coronary vascular turgor. |
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AbstractList | OBJECTIVESThe goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of recruited collateral flow in modulating left ventricular (LV) distensibility during balloon coronary occlusion (BCO).BACKGROUNDAlthough LV distensibility is an important factor affecting acute dilation after myocardial infarction, the response of LV diastolic pressure-volume (P-V) relations to coronary occlusion is inconsistent in humans.METHODSMicromanometer and conductance derived LV P-V loops were serially obtained from 16 patients undergoing percutaneous transluminal coronary angioplasty. Coronary collateral flow recruitment was angiographically evaluated by contralateral and ipsilateral contrast injection during BCO.RESULTSIn the group with poor collateral flow (grades 0-I; n = 8), BCO resulted in a downward and rightward shift of the diastolic P-V relations, where end-diastolic volume (EDV) increased by 13% (p < 0.05) without appreciable change in end-diastolic pressure (EDP; 18 +/- 6 to 18 +/- 8 mm Hg). In contrast, BCO in the group with good collateral flow (grades II-III; n = 8) shifted the diastolic P-V relations upward to the right with a concomitant increase in minimal pressure (min-P; 6 +/- 4 to 10 +/- 5 mm Hg, p < 0.05), EDP (15 +/- 7 to 21 +/- 9 mm Hg, p < 0.05) and EDV (+/- 10%, p < 0.05). Reactive hyperemia after balloon deflation caused a rapid and parallel upward shift of the diastolic P-V relations with a marked increase in min-P and EDP, especially in the group with poor collateral flow, before any improvement in LV contraction or relaxation abnormalities.CONCLUSIONSGrades of coronary filling, either retrograde or anterograde, abruptly modulate LV distensibility through the rapid scaffolding effect of coronary vascular turgor. The goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of recruited collateral flow in modulating left ventricular (LV) distensibility during balloon coronary occlusion (BCO). Although LV distensibility is an important factor affecting acute dilation after myocardial infarction, the response of LV diastolic pressure-volume (P-V) relations to coronary occlusion is inconsistent in humans. Micromanometer and conductance derived LV P-V loops were serially obtained from 16 patients undergoing percutaneous transluminal coronary angioplasty. Coronary collateral flow recruitment was angiographically evaluated by contralateral and ipsilateral contrast injection during BCO. In the group with poor collateral flow (grades 0-I; n = 8), BCO resulted in a downward and rightward shift of the diastolic P-V relations, where end-diastolic volume (EDV) increased by 13% (p < 0.05) without appreciable change in end-diastolic pressure (EDP; 18 +/- 6 to 18 +/- 8 mm Hg). In contrast, BCO in the group with good collateral flow (grades II-III; n = 8) shifted the diastolic P-V relations upward to the right with a concomitant increase in minimal pressure (min-P; 6 +/- 4 to 10 +/- 5 mm Hg, p < 0.05), EDP (15 +/- 7 to 21 +/- 9 mm Hg, p < 0.05) and EDV (+/- 10%, p < 0.05). Reactive hyperemia after balloon deflation caused a rapid and parallel upward shift of the diastolic P-V relations with a marked increase in min-P and EDP, especially in the group with poor collateral flow, before any improvement in LV contraction or relaxation abnormalities. Grades of coronary filling, either retrograde or anterograde, abruptly modulate LV distensibility through the rapid scaffolding effect of coronary vascular turgor. OBJECTIVES The goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of recruited collateral flow in modulating left ventricular (LV) distensibility during balloon coronary occlusion (BCO). BACKGROUND Although LV distensibility is an important factor affecting acute dilation after myocardial infarction, the response of LV diastolic pressure–volume (P-V) relations to coronary occlusion is inconsistent in humans. METHODS Micromanometer and conductance derived LV P-V loops were serially obtained from 16 patients undergoing percutaneous transluminal coronary angioplasty. Coronary collateral flow recruitment was angiographically evaluated by contralateral and ipsilateral contrast injection during BCO. RESULTS In the group with poor collateral flow (grades 0–I; n = 8), BCO resulted in a downward and rightward shift of the diastolic P-V relations, where end-diastolic volume (EDV) increased by 13% (p < 0.05) without appreciable change in end-diastolic pressure (EDP; 18 ± 6 to 18 ± 8 mm Hg). In contrast, BCO in the group with good collateral flow (grades II–III; n = 8) shifted the diastolic P-V relations upward to the right with a concomitant increase in minimal pressure (min-P; 6 ± 4 to 10 ± 5 mm Hg, p < 0.05), EDP (15 ± 7 to 21 ± 9 mm Hg, p < 0.05) and EDV (+10%, p < 0.05). Reactive hyperemia after balloon deflation caused a rapid and parallel upward shift of the diastolic P-V relations with a marked increase in min-P and EDP, especially in the group with poor collateral flow, before any improvement in LV contraction or relaxation abnormalities. CONCLUSIONS Grades of coronary filling, either retrograde or anterograde, abruptly modulate LV distensibility through the rapid scaffolding effect of coronary vascular turgor. |
Author | Remah, Hosam A Igawa, Akihiko Asanoi, Hidetsugu Kameyama, Tomoki Inoue, Hiroshi Joho, Shuji Nozawa, Takashi |
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CitedBy_id | crossref_primary_10_1152_japplphysiol_01304_2011 crossref_primary_10_1007_s00380_017_1092_2 crossref_primary_10_1093_icvts_ivaa222 crossref_primary_10_1097_00003246_200206000_00024 crossref_primary_10_1016_S0735_1097_01_01770_3 crossref_primary_10_1093_eurheartj_ehi051 crossref_primary_10_1097_MAT_0b013e31818a5c93 crossref_primary_10_1152_ajpheart_00704_2006 crossref_primary_10_1016_S0033_0620_00_70008_9 crossref_primary_10_1109_TMI_2014_2360835 |
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Keywords | EDP EF EDV ECG P-V ESV LV Min-P BCO Human Prognosis Coronary artery Instrumentation therapy Cuffed tube Cardiovascular disease Instrumental dilatation Coronary heart disease Myocardial disease Left ventricle Vascular disease Collateral circulation Treatment Ischemia Dilatation Myocardium Hemodynamics |
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The goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of... The goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of recruited... OBJECTIVESThe goals of this study were to elucidate the scaffolding effect of blood-filled coronary vasculature and to determine the functional role of... |
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SubjectTerms | Aged Aged, 80 and over Angioplasty, Balloon, Coronary - adverse effects Biological and medical sciences Cardiology. Vascular system Collateral Circulation Coronary Circulation Coronary heart disease Diastole Female Heart Humans Male Medical sciences Middle Aged Myocardial Ischemia - etiology Myocardial Ischemia - physiopathology Stroke Volume Ventricular Function, Left |
Title | Modulation of left ventricular diastolic distensibility by collateral flow recruitment during balloon coronary occlusion |
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