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Influence of coronary occlusion during PTCA on end-systolic and end-diastolic pressure-volume relations in humans
1Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
Insights
Acute coronary occlusion impairs systolic function, shifting pressure-volume relations. Successful angioplasty resolves these systolic and diastolic changes, showing pressure-volume analysis
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Interventional Cardiology
Background:
- Acute coronary occlusion significantly impacts left ventricular function.
- Understanding systolic and diastolic pressure-volume relations is crucial for assessing cardiac performance during ischemia.
Purpose of the Study:
- To investigate the effects of acute coronary occlusion on systolic and diastolic left ventricular pressure-volume relations.
- To evaluate the utility of pressure-volume analysis in assessing coronary lesions and reperfusion.
Main Methods:
- Studied 10 patients undergoing percutaneous transluminal coronary angioplasty (PTCA).
- Utilized conductance catheter and micromanometer techniques to obtain pressure-volume relations.
- Altered volume load via transient inferior vena caval occlusion during baseline, ischemia, and post-angioplasty.
Main Results:
- Coronary occlusion caused a significant rightward shift in end-systolic pressure-volume relations, indicating systolic dysfunction.
- Proximal occlusions led to greater systolic dysfunction than distal occlusions.
- Diastolic changes included prolonged relaxation and increased apparent stiffness, likely due to altered loading conditions.
Conclusions:
- Pressure-volume analysis effectively reveals systolic and diastolic dysfunction caused by acute coronary occlusion.
- Successful angioplasty reversed the observed functional changes.
- Diastolic abnormalities during ischemia are influenced by right ventricular or pericardial loading, not solely intrinsic diastolic dysfunction.
Abstract:
The influence of acute coronary occlusion on systolic and diastolic left ventricular pressure-volume relations was studied in 10 patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Pressure-volume relations were obtained by conductance catheter and micromanometer techniques and with volume load altered by transient inferior vena caval occlusion. End-systolic and end-diastolic pressure-volume relations were obtained at baseline, during 60-90 seconds of ischemia, and at return to baseline after angioplasty balloon deflation. Coronary occlusion significantly altered systolic and diastolic chamber function. Systolic dysfunction was characterized by a reproducible rightward shift of the end-systolic pressure-volume relation (+25.4 +/- 18.4 ml) that was greater for proximal left anterior descending and circumflex coronary artery occlusions (+41 ml) than for distal or right coronary artery occlusions (+15.4 ml, p less than 0.05). Occlusion also lowered chamber systolic function indexes, such as the end-systolic pressure-volume relation slope (from 4.2 to 2.8 mm Hg/ml) and preload recruitable stroke work (from 97 to 78.6 mm Hg). All systolic (and diastolic) changes were resolved with successful angioplasty. Diastolic abnormalities during angioplasty were characterized by prolonged pressure relaxation and an upward shift of the resting diastolic pressure-volume data and by an apparent increase in chamber elastic stiffness. However, when end-diastolic data from multiple beats during inferior vena caval occlusion were compared, control and ischemic end-diastolic pressure-volume relations displayed little or no difference. Thus, elevations in resting diastolic pressure-volume relations and apparent increase in chamber elastic stiffness during coronary occlusion in humans appear dominated by altered right ventricular or pericardial loading. These data indicate that pressure-volume analysis is useful in assessing the functional significance of coronary lesions and reperfusion.
