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Published on: August 2, 2024
Coronary-aortic interaction during ventricular isovolumic contraction
Marc J van Houwelingen1, Daphne Merkus, Maaike Te Lintel Hekkert
1Experimental Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 50, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. m.vanhouwelingen@erasmusmc.nl
Insights
The pre-systolic aortic pressure perturbation, previously thought to originate from coronary arteries, is not caused by them. Coronary artery occlusion did not affect this pressure wave, refuting the initial hypothesis.
Area of Science:
- Cardiovascular Physiology
- Hemodynamics
- Coronary Circulation
Background:
- The start of isovolumic contraction is potentially detectable in arterial pressure waveforms as a pre-systolic pressure perturbation (AICstart).
- Previous hypotheses suggested retrograde coronary blood flow and pressure waves as the origin of AICstart.
Purpose of the Study:
- To test the hypothesis that AICstart originates from the coronary arteries.
- To investigate the relationship between coronary blood flow dynamics and aortic pressure perturbations.
Main Methods:
- Performed coronary artery occlusion protocols in six swine (LAD, LCx, RCA, and all three simultaneously).
- Measured simultaneous aortic pressure waveforms and coronary blood flow.
- Analyzed pressure perturbations during occlusion and reactive hyperemia.
Main Results:
- Coronary artery occlusions did not alter the aortic pressure perturbation during occlusion or reactive hyperemia.
- Despite significant changes in coronary blood flow deceleration and conductance, the AICstart remained unaffected.
- Statistical analysis showed no significant changes in pressure perturbation (P > 0.20 for occlusion, P > 0.22 for hyperemia).
Conclusions:
- The pre-systolic aortic pressure perturbation (AICstart) does not originate from the coronary arteries.
- The proposed mechanism involving retrograde coronary blood flow is refuted by these findings.
- Further research is needed to identify the true origin of the AICstart.
Abstract:
In earlier work, we suggested that the start of the isovolumic contraction period could be detected in arterial pressure waveforms as the start of a temporary pre-systolic pressure perturbation (AIC(start), start of the Arterially detected Isovolumic Contraction), and proposed the retrograde coronary blood volume flow in combination with a backwards traveling pressure wave as its most likely origin. In this study, we tested this hypothesis by means of a coronary artery occlusion protocol. In six Yorkshire × Landrace swine, we simultaneously occluded the left anterior descending (LAD) and left circumflex (LCx) artery for 5 s followed by a 20-s reperfusion period and repeated this sequence at least two more times. A similar procedure was used to occlude only the right coronary artery (RCA) and finally all three main coronary arteries simultaneously. None of the occlusion protocols caused a decrease in the arterial pressure perturbation in the aorta during occlusion (P > 0.20) nor an increase during reactive hyperemia (P > 0.22), despite a higher deceleration of coronary blood volume flow (P = 0.03) or increased coronary conductance (P = 0.04) during hyperemia. These results show that the pre-systolic aortic pressure perturbation does not originate from the coronary arteries.
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