Summary
In clinical studies stress-induced myocardial ischemia in patients with coronary artery disease is used to evaluate the severity of this disease. The discussion on the importance of some parameters measured during this intervention is controversial, other parameters are difficult to obtain. On the basis of an experimental model of stress-induced myocardial ischemia, we tried to find an index that reflects best this cardiac state.
We therefore compared in eight anesthetized open-chest dogs control conditions with three other hemodynamic states with increasing imbalance between myocardial oxygen demand and oxygen supply: severe stenosis on circumflex coronary artery, 60 s cardiac sympathetic nerve stimulation (CSNS) with a severe stenosis on circumflex coronary artery, and 60 s complete occlusion of circumflex coronary artery. Using a one-way analysis of variance, we found two significantly changed parameters during the stressinduced ischemia: Regional lactate extraction was turned to production (32 ± 4 vs. −4 ± 1%) and the ratio ofdP/dt min todP/dt max was decreased (1.13 ± 0.05 vs. 0.67 ± 0.05; control vs. CSNS with a severe stenosis on circumflex coronary artery).
We conclude that the ratio ofdP/dt min todP/dt max is an easily accessible, sensitive, and dynamic index for characterization of an stress-induced myocardial ischemia.
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References
Battler A, Froelicher VF, Gallagher KP, Kemper WS, Ross J Jr (1980) Dissociation between regional myocardial dysfunction and ECG changes during ischemia in the conscious drug. Circulation 62:735–744
Bretschneider HJ (1961) Sauerstoffbedarf und -versorgung des Herzmuskels. Verh Dtsch Ges Kreislaufforsch 27:32–59
Carroll JD, Hess OM, Hirzel HO, Krayenbühl HP (1983) Exercise-induced ischemia: the influence of altered relaxation on early diastolic pressures. Circulation 67:521–528
Coffmann JD, Gregg DE (1960) Reactive hyperemia characteristics of the myocardium. Am J Physiol 199:1143–1149
Cohen LS, Elliot WC, Klein MD, Gorlin R (1966) Coronary heart disease: clinical, cinearteriographic, and metabolic correlations. Am J Cardiol 17:153–168
Deussen A, Heusch G (1984) Einfluß einer akuten Myokardischämie auf die hämodynamischen Parameter des Restmyokards. Herzmedizin 7:32–35
Dwyer EM (1970) Left ventricular pressure-volume alterations and regional disorders of contraction during myocardial ischemia induced by atrial pacing. Circulation 42:1111–1122
Epstein SE (1978) Value and limitations of the electrocardiographic response to exercise in the assessment of patients with coronary artery disease. Am J Cardiol 43:667–674
Epstein SE, Kent KM, Goldstein RE, Borer JS, Rosing DR (1979) Stategy for evaluating and surgical treatment of the asymptomatic or mildly symptomatic patient with coronary artery disease. Am J Cardiol 43:1015–1025
Feigl EO, D'Alecy LG (1972) Normal arterial blood pH, oxygen, and carbon dioxide tensions in unanesthetized dogs. J Appl Physiol 32:152–153
Froelicher VF, Thompson AJ, Longo MR Jr, Tribwasser JH, Lancaster MC (1976) Value of exercise testing for screening asymptomatic men for latent coronary artery disease. Prog Cardiovasc Dis 18:265–276
Glantz SA, Parmley WW (1978) Factors which affect the diastolic pressure-volume curve. Circ Res 42:171–180
Gould KL, Lipscomb K, Calvert C (1975) Compensatory changes of the distal vascular bed during progressive coronary constriction. Circulation 51:1085–1094
Grossmann W, Serizawa T, Carabello BA (1980) Studies on the mechanism of altered left venticular diastolic pressure-volume relations during ischemia. Eur Heart J [Suppl A] 1:141–147
Heusch G (1985) Sympathische Herznerven und Myokardischämie. Thieme, Stuttgart New York
Heusch G, Deussen A (1983) The effects of cardiac sympathetic nerve stimulation on perfusion of stenotic coronary arteries in the dog. Circ Res 53:8–15
Hillis WS, Friesinger G (1976) Reactive hyperemia: an index of the significance of coronary stenoses. Am Heart J 92:737–740
Kübler W (1969) Tierexperimentelle Untersuchungen zum Myokardstoffwechsel im Angina-pectoris-Anfall und beim Herzinfarkt. Bibl Cardiol 22
Kumada T, Karliner JS, Pouleur H, Gallagher K, Shirato K, Ross J Jr (1979) Effects of coronary occlusion on early ventricular diastolic events in conscious dogs. Am J Physiol 237:H542-H549
Mann T, Goldberg S, Mudge GH, Grossmann W (1979) Factors contributing to altered left ventricular diastolic properties during angina pectoris. Circulation 59:14–20
McLaurin LP, Rolett EL, Grossmann W (1973) Impaired left ventricular relaxation during pacing-induced ischemia. Am J Cardiol 32:751–756
Opie LH, Owen P, Thomas M, Samson R (1973) Coronary sinus lactate measurements in assessment of myocardial ischemia. Am J Cardiol 32:295–305
Owen P, Thomas M, Young V, Opie L (1970) Comparison between metabolic changes in local venous and coronary sinus blood after acute experimental coronary artery occlusion. Am J Cardiol 25:562–570
Papapietro SE, Coghlan HC, Zissermann D, Russell RO, Rackley CE, Rogers WJ (1979) Impaired maximal rate of left ventricular relaxation in patients with coronary artery disease and left ventricular dysfunction. Circualtion 59:984–991
Reindell H, Rosskamm H (1982) Herzkrankheiten. Springer, Berlin Heidelberg New York
Ross J Jr (1976) Electrocardiographic ST segment analysis in the characterization of myocardial ischemia and infarction. Circulation [Suppl 1] 53:173–181
Schipke JD, Deussen A, Heusch G, Thämer V (1984) Assessment of regional myocardial ischemia: Regional vs. coronary sinus blood samples. Pflügers Arch [Suppl] 402:R25
Schipke JD, Heusch G (1982) Sensitivity of left ventricular function to ischemia. Pflügers Arch [Suppl] 392:R8
Takenaka K, Sakamoto T, Inoue H, Amano K, Hada Y, Yamgushi T, Ishimitsu T, Uchiyama I, Kawahara T, Murayama M, Mashima S, Murao S (1982) Pacing echocardiography: Regional wall motion, left ventricular dimension, and R wave amplitude in patients with angina pectoris. Jpn Heart J 23:1–24
Theroux P, Franklin D, Ross J, Kemper WS (1974) Regional myocardial function during acute coronary artery occlusion and its modification by pharmacologic agents in the dog. Circ Res 35:896–908
Watanabe T, Shintani F, Fu LT, Kato K (1975) Maximal rate of left ventricular pressure fall (peak negativedP/dt) in early stage of myocardial ischemia following experimental coronary occlusion. Jpn Heart J 16:583–591
Waters DD, Da Luz P, Wyat HL, Swan HJC, Forrester JS (1977) Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion. Am J Cardiol 39:537–543
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Schipke, J.D., Heusch, G. & Thämer, V. Evaluation of acute stress-induced regional myocardial ischemia: Comparison of regional contractile and metabolic indices to easily accessible global left ventricular indices. Res. Exp. Med. 186, 5–14 (1986). https://doi.org/10.1007/BF01851828
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DOI: https://doi.org/10.1007/BF01851828