Circulation, Vol 84, 211-222, Copyright © 1991 by American Heart Association
JG Bronzwaer, B de Bruyne, CA Ascoop and WJ Paulus
BACKGROUND. Effects of pacing-induced and coronary occlusion myocardial
ischemia on left ventricular (LV) function have been compared only in
anesthetized dogs. Diastolic properties of the same LV anterior wall
segment were therefore compared in 12 patients with single-vessel proximal
left anterior descending coronary artery stenosis at rest, immediately
after 7 +/- 1.2 minutes of pacing, and at the end of a 1- minute balloon
occlusion of coronary angioplasty (CO). METHODS AND RESULTS. Shifts of the
diastolic LV pressure-length relation, derived from simultaneous
tip-micromanometer LV pressure recordings and digital subtraction LV
angiograms, were used as an index of regional diastolic LV distensibility
of the anterior wall segment. Immediately after pacing, LV end-diastolic
pressure rose from 13.5 +/- 3.5 to 23.8 +/- 7.0 mm Hg (p less than 0.01
versus at rest) without a significant change of the LV end-diastolic volume
index (83.1 +/- 18.9 versus 88.4 +/- 16.5 ml/m2), percentage systolic
shortening (%SS) of the ischemic segment fell from 40.1 +/- 10.6% to 25.2
+/- 8.6% (p less than 0.01), and the diastolic LV pressure-radial length
(P-RL) plot of the ischemic segment was shifted upward by 7.1 +/- 5.0 mm Hg
for portions of the plot that overlapped with the diastolic LV P-RL plot at
rest. At the end of CO, LV end-diastolic pressure rose to 20.8 +/- 7.8 mm
Hg (p less than 0.01 versus at rest) and the LV end-diastolic volume index
rose to 95.6 +/- 16.3 ml/m2 (p less than 0.05 versus at rest, p less than
0.05 versus after pacing). Ejection fraction and %SS of the ischemic
segment fell respectively from 76.6 +/- 6.8% to 46.6 +/- 11.4% (p less than
0.01 versus at rest, p less than 0.01 versus after pacing) and from 40.1
+/- 10.6% to 6.4 +/- 8.6% (p less than 0.01 versus at rest, p less than
0.01 versus after pacing). The diastolic LV P-RL plot of the ischemic
segment was shifted upward by 3.1 +/- 2.3 mm Hg for portions of the plot
that overlapped with the diastolic LV P-RL plot at rest. This upward shift
at the end of CO was significantly smaller (p less than 0.05) than that
immediately after pacing. At the end of CO, a correlation (p less than
0.03) was observed for the ischemic segment between %SS and upward shift of
the diastolic LV P-RL plot. CONCLUSIONS. The upward shift of the diastolic
LV P-RL plot, which was used as an index of decreased regional diastolic LV
distensibility, was larger immediately after pacing than at the end of CO.
Persistent systolic shortening of ischemic myocardium seems to be a
prerequisite for a decrease in diastolic distensibility of the ischemic
segment because of the higher %SS of the ischemic segment immediately after
pacing, and because of the correlation at the end of CO between the upward
shift of the diastolic LV P-RL plot and %SS of the ischemic segment.
ARTICLES
Comparative effects of pacing-induced and balloon coronary occlusion ischemia on left ventricular diastolic function in man
St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.
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