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Preconditioning effect during coronary angioplasty in patients with stable angina pectoris
Kenya Sakai1, Togo Yamagata, Hiroki Teragawa
1First Department of Internal Medicine, Hiroshima University School of Medicine.
Insights
Repeated balloon inflations during coronary angioplasty induce a protective preconditioning effect. This effect improves electrocardiogram readings, reduces chest pain, and alters lactate metabolism without involving collateral vessel recruitment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Myocardial Protection
Background:
- Coronary angioplasty procedures can induce transient ischemia.
- Preconditioning is a phenomenon that protects the myocardium from ischemic injury.
- The role of collateral circulation in mediating preconditioning effects during angioplasty is not fully understood.
Purpose of the Study:
- To investigate the involvement of collateral recruitment in the preconditioning effect observed during coronary angioplasty.
- To assess the impact of preconditioning on electrocardiogram parameters, chest symptoms, and lactate metabolism in patients with stable angina pectoris.
Main Methods:
- Sixteen patients with stable angina pectoris underwent three sequential 2-minute balloon inflations.
- Measurements included ST-segment elevation, QT dispersion, chest pain score, and lactate extraction ratio.
- Collateral flow index was assessed using pressure guidewire measurements during balloon inflation.
Main Results:
- Sequential balloon inflations significantly reduced ST-segment elevation, QT dispersion, and chest pain.
- Lactate extraction ratio significantly increased, indicating reduced myocardial lactate production.
- Collateral flow index showed no significant difference, suggesting collateral recruitment was not involved.
Conclusions:
- Repeated balloon inflations during coronary angioplasty elicit a preconditioning effect.
- This preconditioning favorably impacts ST-segment changes, QT dispersion, chest pain, and lactate metabolism.
- The observed preconditioning effect does not appear to be mediated by collateral recruitment.
Objective:
To determine whether collateral recruitment is involved in the preconditioning effect on the electrocardiogram, chest symptoms, and lactate metabolism during coronary angioplasty in patients with stable angina pectoris.
Methods And Patients:
Sixteen patients with stable angina pectoris underwent three consecutive 2-min balloon inflations 5-min apart. The greatest ST elevation (deltaSTmax), the sum of ST elevations in all leads (sum(ST)), and QT dispersion (QTd) were measured at the end of each balloon inflation. Chest pain score was evaluated on a scale ranging from no pain (0) to the most severe pain (10). Lactate extraction ratio (LER) was determined by simultaneous blood sampling from the aorta and the coronary sinus. Collateral flow index (CFI) was derived from simultaneous measurements of mean aortic pressure and coronary wedge pressure obtained from a pressure guidewire during balloon inflation.
Results:
Significant decreases were noted in deltaSTmax (3.3+/-2.1 vs. 3.0+/-1.9 vs. 2.6+/-1.8 mm, p<0.01), sum(ST) (9.7+/-7.2 vs. 8.5+/-6.1 vs. 6.9+/-5.3 mm, p<0.01), QTd (55.3+/-13.8 vs. 46.9+/-9.0 vs. 42.5+/-10.0 ms, p<0.01), and chest pain score (4.3+/-3.1 vs. 2.8+/-2.6 vs. 1.4+/-1.5, p<0.01) during the three sequential balloon inflations. LER significantly increased (-55.5+/-47.8 vs. -36.7+/-34.3 vs. -19.6+/-26.2%, p<0.01), indicating decreased lactate production. No significant difference was observed in CFI (0.16+/-0.10 vs. 0.15+/-0.10 vs. 0.15+/-0.10).
Conclusion:
Repeated balloon inflations during coronary angioplasty elicited a preconditioning effect on ST-segment shift, QT dispersion, chest pain, and lactate production that does not involve collateral recruitment.