Reciprocal relationship between left ventricular filling pressure and the recruitable human coronary collateral circulation

de Marchi, Stefano F.; Oswald, Philipp; Windecker, Stephan; Meier, Bernhard; Seiler, Christian (2005). Reciprocal relationship between left ventricular filling pressure and the recruitable human coronary collateral circulation. European Heart Journal, 26(6), pp. 558-566. Oxford University Press 10.1093/eurheartj/ehi051

[img]
Preview
Text
ehi051.pdf - Published Version
Available under License Publisher holds Copyright.

Download (349kB) | Preview

AIMS The aim of our study in patients with coronary artery disease (CAD) and present, or absent, myocardial ischaemia during coronary occlusion was to test whether (i) left ventricular (LV) filling pressure is influenced by the collateral circulation and, on the other hand, that (ii) its resistance to flow is directly associated with LV filling pressure. METHODS AND RESULTS In 50 patients with CAD, the following parameters were obtained before and during a 60 s balloon occlusion: LV, aortic (Pao) and coronary pressure (Poccl), flow velocity (Voccl), central venous pressure (CVP), and coronary flow velocity after coronary angioplasty (V(Ø-occl)). The following variables were determined and analysed at 10 s intervals during occlusion, and at 60 s of occlusion: LV end-diastolic pressure (LVEDP), velocity-derived (CFIv) and pressure-derived collateral flow index (CFIp), coronary collateral (Rcoll), and peripheral resistance index to flow (Rperiph). Patients with ECG signs of ischaemia during coronary occlusion (insufficient collaterals, n = 33) had higher values of LVEDP over the entire course of occlusion than those without ECG signs of ischaemia during occlusion (sufficient collaterals, n = 17). Despite no ischaemia in the latter, there was an increase in LVEDP from 20 to 60 s of occlusion. In patients with insufficient collaterals, CFIv decreased and CFIp increased during occlusion. Beyond an occlusive LVEDP > 27 mmHg, Rcoll and Rperiph increased as a function of LVEDP. CONCLUSION Recruitable collaterals are reciprocally tied to LV filling pressure during occlusion. If poorly developed, they affect it via myocardial ischaemia; if well grown, LV filling pressure still increases gradually during occlusion despite the absence of ischaemia indicating transmission of collateral perfusion pressure to the LV. With low, but not high, collateral flow, resistance to collateral as well as coronary peripheral flow is related to LV filling pressure in the high range.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

de Marchi, Stefano; Oswald, Philipp; Windecker, Stephan; Meier, Bernhard and Seiler, Christian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Stefano de Marchi

Date Deposited:

25 Apr 2014 13:16

Last Modified:

23 Oct 2019 22:33

Publisher DOI:

10.1093/eurheartj/ehi051

PubMed ID:

15618046

BORIS DOI:

10.7892/boris.40266

URI:

https://boris.unibe.ch/id/eprint/40266

Actions (login required)

Edit item Edit item
Provide Feedback