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Titolo:
Severe regional ischemia alters coronary flow reserve in the remote perfusion area
Autore:
Wu, JC; Yun, JJ; Dione, DP; Heller, EN; Deckelbaum, LI; Sinusas, AJ;
Indirizzi:
Yale Univ, Sch Med, Dept Internal Med, Div Cardiovasc Med,Expt Nucl Cardiol Lab, New Haven, CT 06520 USA Yale Univ New Haven CT USA 06520 ucl Cardiol Lab, New Haven, CT 06520 USA Yale Univ, Sch Med, Dept Diagnost Radiol, New Haven, CT 06520 USA Yale Univ New Haven CT USA 06520 Diagnost Radiol, New Haven, CT 06520 USA
Titolo Testata:
JOURNAL OF NUCLEAR CARDIOLOGY
fascicolo: 1, volume: 7, anno: 2000,
pagine: 43 - 52
SICI:
1071-3581(200001/02)7:1<43:SRIACF>2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
POSITRON-EMISSION-TOMOGRAPHY; MYOCARDIAL BLOOD-FLOW; ARTERY DISEASE; VASODILATOR RESERVE; ENDOTHELIAL DYSFUNCTION; VASCULAR RESERVE; N-13 AMMONIA; ATHEROSCLEROSIS; INFARCTION; PRESSURE;
Keywords:
coronary flow reserve; adenosine; stress perfusion scintigraphy; remote; canine model;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
46
Recensione:
Indirizzi per estratti:
Indirizzo: Sinusas, AJ Yale Univ, Sch Med, Dept Internal Med, Div Cardiovasc Med,ExptNucl Cardiol Lab, POB 208042,333 Cedar St,TE-2, New Haven, CT 06520 USA Yale Univ POB 208042,333 Cedar St,TE-2 New Haven CT USA 06520
Citazione:
J.C. Wu et al., "Severe regional ischemia alters coronary flow reserve in the remote perfusion area", J NUCL CARD, 7(1), 2000, pp. 43-52

Abstract

Background. Clinical and experimental studies suggest that coronary flow reserve (CFR) may be abnormal in regions remote from myocardial infarction, We sought to determine the possible relation among stenosis severity, ischemic dysfunction, and impairment of CFR in remote regions. Methods and Results. In 7 open-chest dogs, acute graded left circumflex (LCX) ischemia was created and maintained based on measurement of the transstenotic (aortic-distal LCX) pressure gradient (measured in millimeters of mercury). Regional thickening was assessed with sonomicrometers, Regional myocardial flow was assessed at rest with radiolabeled microspheres. Doppler flow probes were placed on proximal LCX and left anterior descending (LAD) arteries to measure resting flow and CFR in response to intracoronary injection of adenosine (36 mu g). These parameters were assessed under baseline conditions and during transstenotic gradients of 10, 20, 30, and 40 mm Hg, Increasing LCX stenosis severity caused progressive impairment of LCX CFR: baseline (2.22 +/- 0.10), stenosis 10 (1.80 +/- 0.06), stenosis 20 (1.56 +/-0.08), stenosis 30 (1.30 +/- 0.04), and stenosis 40 (1.17 +/- 0.06) (P < .01 vs baseline). Remote LAD CFR was not altered by mild to moderate LCX stenosis (baseline [2.33 +/- 0.19]; stenosis 10 [2.30 +/- 0.25]; stenosis 20 [2.15 +/- 0.26]), However, critical LCX stenosis producing mild to moderate reduction in thickening in the ischemic region was associated with a significant impairment of LAD CFR: stenosis 30 (1.90 +/- 0.26) and stenosis 40 (1.80 +/- 0.22) (P < .01 vs baseline). These changes in remote CFR persisted after correction for changes in the rate-pressure product. Conclusion. In an acute canine model of progressive LCX coronary stenosis,CFR was impaired in both ischemic and remote nonischemic regions in association with mild to moderate ischemic-induced regional myocardial dysfunction, Thus pharmacologic vasodilation provoked only mild heterogeneity in CFR in the presence of a critical LCX stenosis as a result of concurrent reduction of LAD CFR, This phenomenon warrants further clinical and experimental investigation because it may affect detection of flow heterogeneity during acute ischemia (which induced myocardial dysfunction).

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Documento generato il 19/01/20 alle ore 09:12:21