Clinical phenotype of peripheral atherosclerosis varies with prevalence of cardiovascular risk factors suggesting differences in mechanisms involved in iliac as compared with infrageniculate lesions. Identification of molecular mechanism might have influence on future therapeutic strategies in PAD patients.

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A B S T R A C T We studied the effects of acute pharmacologic and hemodynamic interventions on isovolumic left ventricular relaxation in 19 conscious dogs using micromanometer tip catheters. Isoproterenol (11 studies) augmented peak rate of rise of left ventricular pressure [(+) dP/dt] by 1,275+227 (SE) mm Hg/s (P < 0.001) and dP/dt at an isopressure point of 35 mm Hg during isovolumic relaxation [(-) dP/dt35] by 435±80 mm Hg/s (P < 0.001). Peak (-) dP/dt decreased by 467±89 mm Hg/s (P < 0.002). The time constant, T, derived from the logarithmic fall ofpressure during isovolumic relaxation, shortened from 20±2.8 to 14.9± 1.8 ms (P < 0.003). Calcium ( 11 studies) increased peak (+) dP/dt and (-) dP/dt35 (both P <0.0001); peak (-) dP/dt was unchanged. T shortened from 20.4±1.8 to 17.3±1.5 ms (P < 0.002). Volume (13 studies) did not affect either dP/dt or T. Phenylephrine (13 studies) augmented peak (-) dP/dt, but reduced (-) dP/dt35 (both P < 0.01); T lengthened from 22.1±1.5 to 32.5±1.5 ms (P < 0.01). In 15 studies, rapid atrial pacing increased peak (+) dP/dt and (-) dP/dt35 (both P < 0.01). In the first post-pacing beat, peak (-) dP/dt and (-) dP/dt35 decreased (both P <0.01), although peak (+) dP/dt increased furtier. T paralleled values of (-) dP/dt35. In five dogs, beta

Clinical efficacy of BTK angioplasty is limited in patients with ESRD because of the severely diseased pedal arteries. Further studies are warranted to define subgroups of patients likely to experience a more favorable outcome.