Improved myocardial ischemic response and enhanced collateral circulation with long repetitive coronary occlusion during angioplasty: A prospective study

Cribier, Alain; Korsatz, Luis; Köning, René; Rath, Pratap Chandra; Gamra, Habib; Stix, Günter; Merchant, Shahid; Chan, Charles; Letac, B

doi:10.1016/0735-1097(92)90011-b

Cited by 218 publications

(87 citation statements)

References 24 publications

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“…Murry et al (39) initially showed that myocardium subjected to brief, repeated episodes of sublethal ischemia becomes highly tolerant to the consequences of subsequent lethal ischemia. This endogenous cellular adaptation, more commonly referred to as ischemic preconditioning (IPC), has been documented in many mammalian species, including humans (40)(41)(42), and is not necessarily exclusive to the heart. IPC-mediated cytoprotection is biphasic: an early phase develops within minutes of the initial ischemic event and lasts 2 h to 3 h (39), while the delayed phase is initiated within 12 h and lasts three to four days (43,44).…”

Section: Myocardial Protectionmentioning

confidence: 99%

Coronary vasoregulation in health and disease

Kingma

Rouleau

2007

Canadian Journal of Cardiology

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E arly interests of clinical researchers at the Quebec HeartInstitute focused on various aspects of cardiac physiology, biochemistry (ie, metabolism) and pathology. In the late 1970s, the Quebec Heart Institute recruited Dr Jacques Rouleau, a cardiologist whose primary research interests focused on biophysical mechanisms that regulate the distribution of blood flow across the ventricular wall. The later addition to this laboratory of Dr John Kingma, whose research focused on mechanisms involved in myocardial protection following ischemia-reperfusion injury, created a basic scienceclinical research collaboration that continues today.The principal function of the heart is to supply the different organs in the body with blood containing essential nutrients and oxygen required for their proper functioning. In addition, the heart is essential for the transport of metabolic waste products, the accumulation of which would influence organ function. Mechanical work necessary to pump blood is performed by the myocardium. Proper functioning of the myocardium depends on blood flow in the coronary circulation, which comprises large epicardial conductance vessels originating from the coronary ostia. These large vessels branch into smaller vessels that supply the capillary network responsible for the transport of oxygen and nutrients to the myocytes. Comprehension of mechanisms responsible for regulation of the coronary circulation requires the interpretation of information from several disciplines, including cardiology, physiology, biochemistry and physics; this list is far from exclusive because new information regarding interactions of molecular and mechanical signals is consistently being added to the equation. The present review summarizes several achievements resulting from this research collaboration over the past two decades. REGULATION OF THE DISTRIBUTION OF MYOCARDIAL BLOOD FLOWControl of the coronary circulation involves a host of interactions among mechanical factors, such as arterial pressure, blood flow, ventricular contraction and myocardial wall tension. Suffice it to say that coronary blood flow is never constant but rather adaptive in relation to the metabolic and oxygen requirements of the myocardium; approximately 70% of oxygen transported is extracted from blood flowing in arterial vessels. This intrinsic capacity of arterial vessels to adjust in calibre and maintain constant perfusion over a range of arterial pressures is referred to as 'coronary autoregulation' (Figure 1). Principal mechanisms involved in the control of coronary blood flow include metabolic mediator(s) between myocytes and vascular cells, myogenic tone (induced by stretch) and neurogenic stimulation. However, studies on flow control mechanisms in the coronary circulation are limited because function of intramyocardial resistance vessels cannot be investigated with the currently available techniques. Exercise-induced increases in myocardial oxygen demand are accommodated by increases in coronary blood flow, the latter being controlled by ...

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Section: Myocardial Protectionmentioning

confidence: 99%

Coronary vasoregulation in health and disease

Kingma

Rouleau

2007

Canadian Journal of Cardiology

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“…Several clinical studies have observed progressive decreases in chest pain, ST-segment elevation, and lactate production on subsequent compared with first 60-to 90-second intracoronary balloon inflation. 239,240 The potassium channel blocker glibenclamide can prevent the beneficial effects of repeated balloon angioplasty. Adenosine can mimic the protective effect, 241 whereas adenosine antagonists block it, 242,243 findings that parallel experimental observations in the animal laboratory.…”

Section: Clinical Evidence For Preconditioningmentioning

confidence: 99%

“…Adenosine can mimic the protective effect, 241 whereas adenosine antagonists block it, 242,243 findings that parallel experimental observations in the animal laboratory. Some studies that assessed collateral flow showed no evidence of recruitment during sequential balloon inflations, 239 although one study 240 did report that in about half of the patients, there was recruitment.…”

Section: Clinical Evidence For Preconditioningmentioning

confidence: 99%

Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning

et al. 1998

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“…The modification of ischaemia during the second inflation did not appear to be due to an increase in collateral blood flow. In a subsequent angioplasty study undertaken by Cribier et al, chest pain and ST segment changes were also attenuated during the second balloon inflation but in contrast to Deutsch's study, Cribier observed some opening of collateral vessels after the first inflation [60]. In the most recent study of this type, Taggart et al found that the severity of ischaemia (assessed by cardiac electrogram) during the second balloon inflation was reduced and it is thought that this attenuation of ischaemia could be due to the opening of KATP channels during the first balloon inflation [61].…”

Section: Preconditioning Models In Human Myocardium In Situmentioning

confidence: 78%