Circulation, Vol 85, 2296-2304, Copyright © 1992 by American Heart Association
M Goto, AE Flynn, JW Doucette, A Kimura, O Hiramatsu, T Yamamoto, Y Ogasawara, K Tsujioka, JI Hoffman and F Kajiya
BACKGROUND. Nitroglycerin is effective in relieving myocardial ischemia;
however, intracoronary nitroglycerin often fails to relieve angina and has
been reported to have deleterious effects on subendocardial blood flow. To
understand the mechanisms involved, we evaluated the direct effect of
nitroglycerin on coronary circulation of the ischemic hearts. METHODS AND
RESULTS. We measured the phasic pattern of intramyocardial coronary
arterial flow with an 80-channel, 20-MHz pulsed Doppler ultrasound
flowmeter under moderate to severe coronary artery stenosis (distal
perfusion pressure approximately 45 mm Hg group 1, n = 6) and
transmyocardial blood flow distribution using radioactive microspheres
while maintaining coronary pressure at a low constant level (40 mm Hg,
group 2, n = 6). In anesthetized open-chest dogs, the left main coronary
artery was perfused directly from the right carotid or femoral artery. In
this bypass circuit, pressure was controlled with an occluder or a
reservoir was connected to the circuit. In group 1, the systolic and
diastolic pressures distal to the stenosis decreased significantly after
intracoronary administration of nitroglycerin at maximal coronary flow from
66.5 +/- 18.5 to 56.5 +/- 13.8 mm Hg (p less than 0.01) and from 36.6 +/-
14.4 to 27.5 +/- 8.9 mm Hg (p less than 0.01), respectively. The phasic
pattern of the septal artery flow was predominantly diastolic and was
characterized by systolic reverse flow even in the absence of stenosis.
Coronary stenosis increased systolic reverse flow. Nitroglycerin increased
diastolic forward flow (p less than 0.05) but augmented systolic reverse
flow markedly (p less than 0.001). In group 2, nitroglycerin increased
subepicardial flow (p less than 0.05) but failed to increase subendocardial
flow. With the administration of nitroglycerin, the
subendocardial-to-subepicardial flow ratio decreased significantly from
0.73 +/- 0.19 to 0.32 +/- 0.14 (p less than 0.01). CONCLUSIONS. The
increased systolic reverse flow after intracoronary administration of
nitroglycerin may be closely related to failure of subendocardial blood
flow to increase with increase subepicardial flow.
ARTICLES
Effect of intracoronary nitroglycerin administration on phasic pattern and transmural distribution of flow during coronary artery stenosis
Department of Medical Engineering and Systems Cardiology, Kawasaki Medical School, Kurashiki, Japan.
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