Circulation, Vol 81, 447-460, Copyright © 1990 by American Heart Association
DA Kass, M Midei, J Brinker and WL Maughan
The influence of acute coronary occlusion on systolic and diastolic left
ventricular pressure-volume relations was studied in 10 patients undergoing
percutaneous transluminal coronary angioplasty (PTCA). Pressure-volume
relations were obtained by conductance catheter and micromanometer
techniques and with volume load altered by transient inferior vena caval
occlusion. End-systolic and end-diastolic pressure- volume relations were
obtained at baseline, during 60-90 seconds of ischemia, and at return to
baseline after angioplasty balloon deflation. Coronary occlusion
significantly altered systolic and diastolic chamber function. Systolic
dysfunction was characterized by a reproducible rightward shift of the
end-systolic pressure-volume relation (+25.4 +/- 18.4 ml) that was greater
for proximal left anterior descending and circumflex coronary artery
occlusions (+41 ml) than for distal or right coronary artery occlusions
(+15.4 ml, p less than 0.05). Occlusion also lowered chamber systolic
function indexes, such as the end-systolic pressure-volume relation slope
(from 4.2 to 2.8 mm Hg/ml) and preload recruitable stroke work (from 97 to
78.6 mm Hg). All systolic (and diastolic) changes were resolved with
successful angioplasty. Diastolic abnormalities during angioplasty were
characterized by prolonged pressure relaxation and an upward shift of the
resting diastolic pressure-volume data and by an apparent increase in
chamber elastic stiffness. However, when end-diastolic data from multiple
beats during inferior vena caval occlusion were compared, control and
ischemic end-diastolic pressure-volume relations displayed little or no
difference. Thus, elevations in resting diastolic pressure- volume
relations and apparent increase in chamber elastic stiffness during
coronary occlusion in humans appear dominated by altered right ventricular
or pericardial loading. These data indicate that pressure- volume analysis
is useful in assessing the functional significance of coronary lesions and
reperfusion.
ARTICLES
Influence of coronary occlusion during PTCA on end-systolic and end- diastolic pressure-volume relations in humans
Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
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