Circulation, Vol 82, 2044-2051, Copyright © 1990 by American Heart Association
E Deutsch, M Berger, WG Kussmaul, JW Hirshfeld Jr, HC Herrmann and WK Laskey
The clinical, electrocardiographic, and coronary hemodynamic responses to
sequential 90-second occlusions of the left anterior descending coronary
artery in 12 patients undergoing elective percutaneous transluminal
coronary angioplasty were examined. Transmyocardial lactate metabolism was
examined in an additional group of seven patients with clinical and
hemodynamic features similar to the first group. We noted that in
comparison with the initial balloon occlusion the second occlusion was
characterized by less subjective anginal discomfort, less ST segment shift
(0.44 +/- 0.13 versus 0.21 +/- 0.07 mV, p = 0.01), and lower mean pulmonary
artery pressure (25 +/- 1.0 versus 20 +/- 1.7 mm Hg, p = 0.005). In
addition, for the same heart rate-blood pressure product, cardiac vein flow
during the second inflation was significantly lower than that recorded
during the first inflation (96 +/- 1.4 versus 83 +/- 2.4 ml/min, p =
0.005). Finally, there was significantly less myocardial lactate production
during the second inflation (lactate extraction ratio: first inflation,
-0.11 +/- 0.03; second inflation, -0.03 +/- 0.02; p = 0.04). We conclude
that the lessened clinical, electrocardiographic, hemodynamic, and
metabolic evidence of myocardial ischemia during the second of two periods
of coronary artery occlusion during percutaneous transluminal coronary
angioplasty supports the concept of adaptation to myocardial ischemia
(ischemic preconditioning).
ARTICLES
Adaptation to ischemia during percutaneous transluminal coronary angioplasty. Clinical, hemodynamic, and metabolic features
Department of Medicine, University of Pennsylvania, School of Medicine, Philadelphia.
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K. Hu, G.-R. Li, and S. Nattel Adenosine-induced activation of ATP-sensitive K+ channels in excised membrane patches is mediated by PKC Am J Physiol Heart Circ Physiol, February 1, 1999; 276(2): H488 - H495. [Abstract] [Full Text] [PDF]
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C. E. Schotborgh and A. A.M. Wilde ATP-Sensitive Potassium Channel Openers and Blockers in the Cardiovascular System: Physiology, Pharmacology, and Clinical Effects Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1998; 2(3): 243 - 255. [Abstract] [PDF]
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H. T. Lee, R. Bolli, and M. A. Leesar Adenosine Pretreatment of Human Myocardium and Ischemic Preconditioning • Response Circulation, June 9, 1998; 97(22): 2279 - 2279. [Full Text]
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R. A. Kloner, R. Bolli, E. Marban, L. Reinlib, and E. Braunwald Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning : An NHLBI Workshop Circulation, May 19, 1998; 97(18): 1848 - 1867. [Full Text] [PDF]
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 H. Shiraki, T. Yoshikawa, T. Anzai, K. Negishi, T. Takahashi, Y. Asakura, M. Akaishi, H. Mitamura, and S. Ogawa Association between Preinfarction Angina and a Lower Risk of Right Ventricular Infarction N. Engl. J. Med., April 2, 1998; 338(14): 941 - 947. [Abstract] [Full Text] [PDF]
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B. S. Cain, D. R. Meldrum, X. Meng, B. D. Shames, A. Banerjee, and A. H. Harken Calcium Preconditioning in Human Myocardium Ann. Thorac. Surg., April 1, 1998; 65(4): 1065 - 1070. [Abstract] [Full Text] [PDF]
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R. W. Illes and K. D. Swoyer Prospective, Randomized Clinical Study of Ischemic Preconditioning as an Adjunct to Intermittent Cold Blood Cardioplegia Ann. Thorac. Surg., March 1, 1998; 65(3): 748 - 752. [Abstract] [Full Text] [PDF]
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 E. R. Schwarz, J. Fleischhauer, H. Montino, R. Chakupurakal, M. Foresti, T. Schuetz, S. Sack, M. Mohri, M. Arras, W. Schaper, et al. Infarct Size Reduction by Ischemic Preconditioning is a Monophasic, Short-Lived Phenomenon in Anesthetized Pigs Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1998; 3(1): 63 - 70. [Abstract] [PDF]
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E.-X. Lu, S.-X. Chen, M.-D. Yuan, T.-H. Hu, H.-C. Zhou, W.-J. Luo, G.-H. Li, and L.-M. Xu Preconditioning Improves Myocardial Preservation in Patients Undergoing Open Heart Operations Ann. Thorac. Surg., November 1, 1997; 64(5): 1320 - 1324. [Abstract] [Full Text]
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F. Tomai, F. Crea, A. Gaspardone, F. Versaci, A. S. Ghini, R. De Paulis, L. Chiariello, and P. A. Gioffre Phentolamine Prevents Adaptation to Ischemia During Coronary Angioplasty : Role of {alpha}-Adrenergic Receptors in Ischemic Preconditioning Circulation, October 7, 1997; 96(7): 2171 - 2177. [Abstract] [Full Text]
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C. A. Piot, D. Padmanaban, P. C. Ursell, R. E. Sievers, and C. L. Wolfe Ischemic Preconditioning Decreases Apoptosis in Rat Hearts In Vivo Circulation, September 2, 1997; 96(5): 1598 - 1604. [Abstract] [Full Text]
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 X.-P. Yang, Y.-H. Liu, G. M. Scicli, C. R. Webb, and O. A. Carretero Role of Kinins in the Cardioprotective Effect of Preconditioning : Study of Myocardial Ischemia/Reperfusion Injury in B2 Kinin Receptor Knockout Mice and Kininogen-Deficient Rats Hypertension, September 1, 1997; 30(3): 735 - 740. [Abstract] [Full Text]
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M. V. Cohen, J. D. Thornton, C. S. Thornton, H. Sato, T. Miki, and J. M. Downey INTRAVENOUS CO-INFUSION OF ADENOSINE AND NOREPINEPHRINE PRECONDITIONS THE HEART WITHOUT ADVERSE HEMODYNAMIC EFFECTS J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 236 - 242. [Abstract] [Full Text]
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J. C. Cleveland Jr, D. R. Meldrum, B. S. Cain, A. Banerjee, and A. H. Harken Oral Sulfonylurea Hypoglycemic Agents Prevent Ischemic Preconditioning in Human Myocardium : Two Paradoxes Revisited Circulation, July 1, 1997; 96(1): 29 - 32. [Abstract] [Full Text]
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M. A. Leesar, M. Stoddard, M. Ahmed, J. Broadbent, and R. Bolli Preconditioning of Human Myocardium With Adenosine During Coronary Angioplasty Circulation, June 3, 1997; 95(11): 2500 - 2507. [Abstract] [Full Text]
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P. L. Capecchi, F. L. Pasini, G. Cati, M. Colafati, A. Acciavatti, L. Ceccatelli, S. Petri, A. de Lalla, T. Di Perri, and P. L. Capecchi Experimental Model of Short-Time Exercise-Induced Preconditioning in POAD Patients Angiology, June 1, 1997; 48(6): 469 - 480. [Abstract] [PDF]
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A. Babenko and G. Vassort Enhancement of the ATP-Sensitive K+ Current by Extracellular ATP in Rat Ventricular Myocytes : Involvement of Adenylyl Cyclase–Induced Subsarcolemmal ATP Depletion Circ. Res., April 19, 1997; 80(4): 589 - 600. [Abstract] [Full Text]
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S. J. Kapadia, J. S. Terlato, and A. S. Most Presence of a Critical Coronary Artery Stenosis Does Not Abolish the Protective Effect of Ischemic Preconditioning Circulation, March 4, 1997; 95(5): 1286 - 1292. [Abstract] [Full Text]
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R. L. Engler and D. M. Yellon Sulfonylurea KATP Blockade in Type II Diabetes and Preconditioning in Cardiovascular Disease: Time for Reconsideration Circulation, November 1, 1996; 94(9): 2297 - 2301. [Full Text]
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V. Pasceri, G. A. Lanza, G. Patti, P. Pedrotti, F. Crea, and A. Maseri Preconditioning by Transient Myocardial Ischemia Confers Protection Against Ischemia-Induced Ventricular Arrhythmias in Variant Angina Circulation, October 15, 1996; 94(8): 1850 - 1856. [Abstract] [Full Text]
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Y. Birnbaum, K. Przyklenk, and R. A. Kloner Time Frame of Ischemic Preconditioning: Is It Clinically Relevant? Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 1996; 1(4): 339 - 346. [PDF]
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H. Ogino, R. T. Smolenski, M. Zych, A.-M. L. Seymour, and M. H. Yacoub Influence of Preconditioning on Rat Heart Subjected to Prolonged Cardioplegic Arrest Ann. Thorac. Surg., August 1, 1996; 62(2): 469 - 474. [Abstract] [Full Text]
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M. Haude, G. Caspari, D. Baumgart, R. Brennecke, J. Meyer, and R. Erbel Comparison of Myocardial Perfusion Reserve Before and After Coronary Balloon Predilatation and After Stent Implantation in Patients With Postangioplasty Restenosis Circulation, August 1, 1996; 94(3): 286 - 297. [Abstract] [Full Text]
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