Assessment of coronary conductance and resistance vessel reactivity in response to nitroglycerin, ergonovine and adenosine: In vivo studies with simultaneous intravascular two-dimensional and Doppler ultrasound

Sudhir, Krishnankutty; MacGregor, John S.; Barbant, Sophie; Foster, Elyse; Fitzgerald, Peter J.; Chatterjee, Kanu; Yock, Paul G.

doi:10.1016/0735-1097(93)90255-y

Cited by 96 publications

(35 citation statements)

References 42 publications

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“…However, nitrates also affect resistance vessels Ͼ100 m in the microcirculation (10), especially in the early transition period before compensatory action by autoregulatory control. A 50% increase in coronary flow has been reported 2 min after a 0.2 mg bolus of nitroglycerin (22). It is therefore not unlikely that the 1 mg dose of isosorbide dinitrate induced a transient decline in microvascular resistance during the 1-min measurement period.…”

Section: Discussionmentioning

confidence: 98%

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Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique

Kolyva¹,

Spaan²,

Piek³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

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Kolyva C, Spaan JA, Piek JJ, Siebes M. Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique. Am J Physiol Heart Circ Physiol 295: H482-H490, 2008. First published May 30, 2008 doi:10.1152/ajpheart.00223.2008.-A novel single-point technique to calculate local arterial wave speed (SPc) has recently been presented and applied in healthy human coronary arteries at baseline flow. We investigated its applicability for conditions commonly encountered in the catheterization laboratory. Intracoronary pressure (Pd) and Doppler velocity (U) were recorded in 29 patients at rest and during adenosine-induced hyperemia in a distal segment of a normal reference vessel and downstream of a single stenosis before and after revascularization. Conduit vessel tone was minimized with nitroglycerin. Microvascular resistance (MR) and SPc were calculated from Pd and U. In the reference vessel, SPc decreased from 21.5 m/s (SD 8.0) to 10.5 m/s (SD 4.1) after microvascular dilation (P Ͻ 0.0001). SPc was substantially higher in the presence of a proximal stenosis and decreased from 34.4 m/s (SD 18.2) at rest to 27.5 m/s (SD 13.4) during hyperemia (P Ͻ 0.0001), with a concomitant reduction in Pd by 20 mmHg and MR by 55.4%. The stent placement further reduced hyperemic MR by 26% and increased Pd by 26 mmHg but paradoxically decreased SPc to 13.1 m/s (SD 7.7) (P Ͻ 0.0001). Changes in SPc correlated strongly with changes in MR (P Ͻ 0.001) but were inversely related to changes in Pd (P Ͻ 0.01). In conclusion, the single-point method yielded erroneous predictions of changes in coronary wave speed induced by a proximal stenosis and distal vasodilation and is therefore not appropriate for estimating local wave speed in coronary vessels. Our findings are well described by a lumped reservoir model reflecting the "windkesselness" of the coronary arteries. coronary hemodynamics; pulse wave velocity; microvascular resistance; intramyocardial pump; stenosis ARTERIAL PULSE WAVE VELOCITY is directly related to the elastic properties of the vessel wall by the well-known MoensKorteweg equation (14) and represents an important marker of vascular pathology associated with the risk of cardiovascular events (2,17,27). Consequently, wave speed is influenced by factors that affect wall stiffness, such as age, vascular disease, distending pressure, and vascular tone (2,11,13,15,23). It is also a fundamental parameter required in wave intensity analysis for the separation of traveling waves into their forward and backward components (4,8,16).The average wave speed along a vessel segment with fairly uniform wall properties can be determined with the standard foot-to-foot method from the pulse delay between two measurement locations (1, 14). Local wave speed based on simultaneous pressure and velocity measurements at a single location can be obtained by the pressure-velocity loop method (7, 8), but it requires unidirectional waves during at least part of the cycle. Neither method is suitable for the coronary cir...

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Section: Discussionmentioning

confidence: 98%

“…The first intervention was the administration of adenosine, which dilates coronary resistance vessels in the microcirculation and not the larger coronary arteries (10,22). This intervention should therefore have no direct effect on local wave speed measured in an epicardial conductance vessel.…”

mentioning

confidence: 99%

Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique

Kolyva¹,

Spaan²,

Piek³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

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“…24 Nitric oxide will dilate coronary artery size even at the segments of impaired endothelial function. 24 Sudhir et al 25 demonstrated that nitroglycerin predominantly influences coronary conductance arteries and has considerable effect on increased cross-sectional area with minimal effect on coronary resistance. This is not consistent with our finding which showed that nitroglycerin had a similar effect on conduit (cross-section area increased by 28%) and resistance vessels (vascular resistance decreased by 21%).…”

Section: Effect Of Nitroglycerinmentioning

confidence: 99%

Effects of distension of urinary bladder on coronary conduit and resistance vessels in hyperlipidemic patients

Lee

Tsai

2002

Clinical Cardiology

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SummaryBackground: Distension of the urinary bladder reflexly causes a change of coronary vasomotor response. The effect of such distension on the coronary circulation in hyperlipidemic patients, a condition with impaired endothelial function, remains unknown.Hypothesis: We tested the hypothesis whether urinary bladder distension caused an exaggerated vasomotor response of epicardial and resistance vasoconstriction in hyperlipidemic patients.Methods: Thirty patients with early atherosclerosis (< 50% diameter stenosis) were divided into three groups: Group 1 (n = 10): hyperlipidemia without doxazosin administration; Group 2 (n = 10): hyperlipidemia with pretreatment of ␣1-adrenergic receptor blocker (oral doxazosin 2 mg); and Group 3 (n = 10): normolipidemia. A prospective analysis of the results of quantitative angiograms, intracoronary Doppler flow, and lactate concentrations from aortic root and coronary sinus was performed during distension of urinary bladder.Results: Bladder distension significantly decreased coronary diameter at the stenotic segments (p = 0.004), coronary blood flow (p = 0.05), and increased coronary resistance (p = 0.006) compared with baseline values, in Group 1 patients. In

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“…Furthermore, Adenosine acts mainly at the level of the microcirculation and does not alter significantly the diameter of the coronary artery. Adenosine is administered intravenously (0.140 mg/kg/min) for 5 minutes (Lapeyre AC III et al, 2004, Sudhir K et al, 1993, Verani MS, 1991, Wilson R et al, 1990. The normal range of CFVR for both men and women is ≥ 2.7.…”

Section: Coronary Flow Reservementioning

confidence: 99%

Role of Transthoracic Echocardiography in Visualization of the Coronary Arteries and Assessment of Coronary Flow Reserve

Baghdady¹,

Hishmat²,

Farook³

2012

Echocardiography - New Techniques

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Assessment of coronary conductance and resistance vessel reactivity in response to nitroglycerin, ergonovine and adenosine: In vivo studies with simultaneous intravascular two-dimensional and Doppler ultrasound

Cited by 96 publications

References 42 publications

Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique

Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique

Effects of distension of urinary bladder on coronary conduit and resistance vessels in hyperlipidemic patients

Role of Transthoracic Echocardiography in Visualization of the Coronary Arteries and Assessment of Coronary Flow Reserve

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