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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