Progressive decrease in myocardial ischemia assessed by intracoronary electrocardiogram during successive and prolonged coronary occlusions in angioplasty

Köning, René; Cribier, Alain; Korsatz, Luis; Stix, Günter; Chan, Charles; Eltchaninoff, Hélène; Letac, B

doi:10.1016/0002-8703(93)90056-f

Cited by 16 publications

(10 citation statements)

References 9 publications

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“…There are some studies concerning the change in ST segment during repeated coronary occlusion [2][3][4]. Those studies reported a decrease in ST segment elevation during the second occlusion, in contrast to our findings of an increase.…”

Section: Discussioncontrasting

confidence: 99%

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Parasympathetic Tone Affects Electrocardiographic Preconditioning during Right Coronary Angioplasty

Tsuchiya

Nii²,

Shirai³

et al. 1998

Cardiology

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We investigated whether parasympathetic tone may affect ischemic preconditioning in terms of ST segment alteration during coronary angioplasty. Coronary balloon angioplasty was performed in 19 patients with angina and isolated right coronary artery disease. Parasympathetic tone was assessed by frequency domain parameters of heart rate variability using 24-hour electrocardiographic recordings obtained before angioplasty. Logistic regression analysis showed the high frequency component to be an independent predictor of the change in ST elevation induced by the second balloon inflation. An increase in parasympathetic tone was related to ischemic preconditioning with respect to the electrocardiographic alterations observed in these patients.

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Section: Discussioncontrasting

confidence: 99%

“…In humans, the ST segment elevation is reportedly reduced by repeated occlusion of the coronary artery during balloon angioplasty [2][3][4]. This ST alteration is thought to be related to a preconditioning effect.…”

Section: Introductionmentioning

confidence: 99%

Parasympathetic Tone Affects Electrocardiographic Preconditioning during Right Coronary Angioplasty

Tsuchiya

Nii²,

Shirai³

et al. 1998

Cardiology

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“…Two min of ischemia, as used in the present study, induced a preconditioning effect in rat [16], but not in rabbit [17]. In recent clinical studies, ischemic tolerance has been documented during the second of two balloon inflations in coronary angioplasty [5,7]. It has been reported that repeated episodes of myocardial ischemia stimulate the recruitment of collateral channels in humans [6,18].…”

Section: Ischemic Tolerancementioning

confidence: 52%

“…Recent clinical studies have also demonstrated ischemic tolerance induced by repeated brief coronary occlusions during percutaneous transluminal coronary angioplasty (PTCA) [5][6][7]. Although reactive hyperemia is considered to rellect the severity of preceding myocardial ischemia in animal models [8,9], some experimental studies have shown a progressive decrease in coronary hyperemic flow during repeated coronary occlusions in dog hearts [10,11].…”

Section: Introductionmentioning

confidence: 99%

Enhancement of coronary reactive hyperemia in patients with ischemic myocardial tolerance during angioplasty

et al. 1996

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The purpose of this study was to elucidate the effect of repeated brief coronary occlusions on reactive hyperemia during percutaneous transluminal coronary angioplasty (PTCA) in patients with or without ischemic tolerance. Seventeen patients undergoing PTCA for chronic stable angina were studied. Patients with well developed collateral vessels were excluded. After successful predilatation, coronary flow velocity was recorded with the use of a Doppler flow guide wire, and reactive hyperemia was assessed immediately after each of two 2-min coronary occlusions followed by 2 mins of reperfusion. The intracoronary electrocardiogram (icECG) was recorded via the flow guide wire placed in the center of the ischemic zone. Patients were divided into two groups: those who showed a reduction of ST elevation in the icECG recorded at the time of the second coronary occlusion (group I), and those who showed no difference in ST elevation between the two occlusions (group II). There were no significant differences in blood pressure, heart rate, or baseline coronary flow velocity between the two groups before the first occlusion, but the ST elevation at the time of the first coronary occlusion was greater in group I than in group II (8.9 +/- 6.2 versus 1.1 +/- 2.0 mm, P < 0.01). Reactive hyperemia was significantly greater after the second coronary occlusion than after the first in group I (22.1 +/- 15.8 versus 30.4 +/- 21.0 cm/s, P < 0.05), but it did not change in group II (25.6 +/- 13.0 versus 23.5 +/- 11.2 cm/s NS). Reactive hyperemia was enhanced in patients with ischemic tolerance who showed a reduction in St elevation in the icECG. These results suggest that observed reactive hyperemia does not necessarily reflect the severity of ischemia.

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“…3 Percutaneous transluminal coronary angioplasty (PTCA) can be used as an experimental model for inducing controlled episodes of myocardial ischaemia in humans, and several investigators have attempted to induce ischaemic preconditioning during PTCA by exposing patients to repetitive cycles of balloon inflation and deflation. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] To examine a possible role of ATP sensitive potassium channels in the development of preconditioning, we produced repeated coronary occlusions in patients undergoing coronary angioplasty. The patients were randomised in a double blind fashion to treatment with either an ATP sensitive potassium channel opener (pinacidil), a potassium channel blocker (glibenclamide), or placebo.…”

mentioning

confidence: 99%

Pharmacological modulation of the ATP sensitive potassium channels during repeated coronary occlusions: no effect on myocardial ischaemia or function

Lindhardt

Gadsbøll

Kelbæk

et al. 2004

Heart

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Background: Repeated episodes of myocardial ischaemia may lead to ischaemic preconditioning. This is believed to be mediated by the ATP sensitive potassium channels. Objective: To examine the effect of pharmacological modulation of the ATP sensitive potassium channels during repeated coronary occlusions. Design: Double blind, double dummy study. Methods: 38 patients with a proximal stenosis of the left anterior descending coronary artery and no visible coronary collateral vessels underwent three identical 90 second balloon occlusions, each followed by five minutes of reperfusion. The patients were randomised to pinacidil 25 mg, glibenclamide 10.5 mg, or matching placebo 90 minutes before the start of the procedure. Myocardial ischaemia was measured by continuous monitoring of ECG ST segment changes. Changes in left ventricular function were recorded with a miniature radionuclide detector, and angina was scored on the Borg scale. Results: In all patients the first balloon occlusion led to significant ST segment elevation, a clear decrease in left ventricular ejection fraction, and angina pectoris. This response was not attenuated at the second or third balloon occlusion, either in the placebo group or in the patients pretreated with pinacidil or glibenclamide. Conclusions: Under the given experimental conditions, this randomised and double blind study did not support the view that the human myocardium has an intrinsic protective mechanism that is activated by short lasting episodes of ischaemia.

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Progressive decrease in myocardial ischemia assessed by intracoronary electrocardiogram during successive and prolonged coronary occlusions in angioplasty

Cited by 16 publications

References 9 publications

Parasympathetic Tone Affects Electrocardiographic Preconditioning during Right Coronary Angioplasty

Parasympathetic Tone Affects Electrocardiographic Preconditioning during Right Coronary Angioplasty

Enhancement of coronary reactive hyperemia in patients with ischemic myocardial tolerance during angioplasty

Pharmacological modulation of the ATP sensitive potassium channels during repeated coronary occlusions: no effect on myocardial ischaemia or function

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