Role of oxygen-derived free radicals in myocardial edema and ischemia in coronary microvascular embolization.

Hori, Masatsugu; Gotoh, K; Kitakaze, Masafumi; Iwai, Kunimitsu; Iwakura, Katsuomi; Sato, Hiroshi; Koretsune, Yukihiro; Inoue, Michitoshi; Kitabatake, Akira; Kamada, Takenobu

doi:10.1161/01.cir.84.2.828

Cited by 69 publications

(37 citation statements)

References 38 publications

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“…10,11 This phenomenon seems to be due to adenosine-induced hyperemia of the myocardium surrounding the embolized microregions. 12 This interpretation is further supported by a study reporting that patients who experienced a prolonged hyperemic response after a percutaneous intervention had higher creatine phosphokinase values than patients without hyperemia. 13 Similar to those findings, we found a significant difference in cardiac enzyme levels between the patients with an optimal and suboptimal postprocedural CFVR value.…”

Section: Determinants Of Impaired Cfvr After Angioplastymentioning

confidence: 81%

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

et al. 2002

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Background-Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. Methods and Results-As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow-guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (Ն2.5 or Ͻ2.5) at the end of the procedure. A CFVR Ͻ2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR

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Section: Determinants Of Impaired Cfvr After Angioplastymentioning

confidence: 81%

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

et al. 2002

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“…Inflammatory mediators such as TNF-␣, free oxygen radicals, and interleukins have been shown to play a major role in contractile dysfunction in the microembolized myocardium following coronary microembolization (15,17,34), possibly indicating the role of inflammation and/or edema in its pathogenesis. Such mediators can likely more easily diffuse into the perfused myocardium from the interfacial region between perfused and nonperfused myocardium (i.e., proportional to the interface's surface area) rather than from deep within the nonperfused myocardium, which would make the effect more proportional to the volume of nonperfused myocardium.…”

Section: Discussionmentioning

confidence: 99%

Relationship between surface area of nonperfused myocardium and extravascular extraction of contrast agent following coronary microembolization

Malyar

Lerman

Gössl

et al. 2011

American Journal of Physiology-Regulatory, Integrative and Comp

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Malyar NM, Lerman LO, Gössl M, Beighley PE, Ritman EL. Relationship between surface area of nonperfused myocardium and extravascular extraction of contrast agent following coronary microembolization. Am J Physiol Regul Integr Comp Physiol 301: R430-R437, 2011. First published May 4, 2011 doi:10.1152/ajpregu.00428.2010.-Myocardial microvascular permeability and coronary sinus concentration of muscle metabolites have been shown to increase after myocardial ischemia due to epicardial coronary artery occlusion and reperfusion. However, their association with coronary microembolization is not well defined. This study tested the hypothesis that acute coronary microembolization increases microvascular permeability in the porcine heart. The left anterior descending perfusion territories of 34 anesthetized pigs (32 Ϯ 3 kg) were embolized with equal volumes of microspheres of one of three diameters (10, 30, or 100 m) and at three different doses for each size. Electron beam computed tomography (EBCT) was used to assess in vivo, microvascular extraction of a nonionic contrast agent (an index of microvascular permeability) before and after microembolization with microspheres at baseline and during adenosine infusion. A high-resolution three-dimensional microcomputed tomography (micro-CT) scanner was subsequently used to obtain ex vivo, the volume and corresponding surface area of the embolized myocardial islands within the perfusion territories of the microembolized coronary artery. EBCT-derived microvascular extraction of contrast agent increased within minutes after coronary microembolization (P Ͻ 0.001 vs. baseline and vs. control values). The increase in coronary microvascular permeability was highly correlated to the micro-CT-derived total surface area of the nonperfused myocardium (r ϭ 0.83, P Ͻ 0.001). In conclusion, myocardial extravascular accumulation of contrast agent is markedly increased after coronary microembolization and its magnitude is in proportion to the surface area of the interface between the nonperfused and perfused territories. microspheres; EBCT; micro-CT; microvascular permeability A BALANCE BETWEEN DELIVERY of vital nutrients and removal of waste products from the myocardium is pivotal for maintaining the physiological contractile function of the myocytes and for the coordinated electrical conductance along the cells' membranes. However, it has been shown that myocardial microvascular permeability can change under various pathologic and metabolic circumstances such as diabetes mellitus (24, 41), hypercholesterolemia (32), hypertension (31), and acute myocardial ischemia followed by reperfusion (29). Embolization of microscopic plaque debris into the distal coronary bed during coronary interventions is a common and frequent event (9, 10, 35) that might be associated with microinfarctions and with adverse clinical outcome (7, 10).We have previously demonstrated that experimental coronary microembolization leads to a decrease in regional myocardial contractility that is proportional to the surface...

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“…Previous studies have also shown that ME induces the release of inflammatory mediators such as interleukins-6 and -8, tumor necrosis factor (TNF)-␣, 12,13 and free oxygen radicals 14,25 from the ischemic myocardium into the surrounding, nonischemic myocardium. For example, Thielmann et al 11 showed in a dog model that intracoronary infusion of exogenous TNF-␣ induced contractile dysfunction even in the absence of ME.…”

Section: Malyar Et Al Nonperfused Myocardium-to-effect Relation 1949mentioning

confidence: 99%

“…8 -10 Inflammatory cytokines have been shown to depress myocardial function 11 ; hence, it is likely that MEinduced generation of proinflammatory cytokines plays a role in myocardial contractile dysfunction after ME. [12][13][14] It seems evident that such humoral agents can readily diffuse from the surface zone of small, ischemic volumes (ie, "microperfusion defects") into nearby normal tissue, whereas this diffusion is decreasingly likely from tissue deeper within the individual ischemic volumes. Therefore, we hypothesized that in ME, the total surface area (SA) rather than the volume of embolized, nonperfused myocardium (NPM) predominantly determines regional and global LV dysfunction.…”

mentioning

confidence: 99%

Relation of Nonperfused Myocardial Volume and Surface Area to Left Ventricular Performance in Coronary Microembolization

et al. 2004

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Background-After occlusion of an epicardial artery, left ventricular (LV) dysfunction is closely related to the volume of nonperfused myocardium (NPM). The impact of coronary microembolization (ME) on LV function, however, is larger relative to the total volume of NPM. We hypothesized that the total surface area (SA), rather than the total volume, of NPM is the major determinant of ME-induced LV dysfunction. Methods and Results-We injected microspheres of 10-, 30-, or 100-m diameter at each of 3 doses selectively into the left anterior descending coronary artery of 48 anesthetized pigs. Electron beam computed tomography (CT) was used to measure regional myocardial perfusion and changes in LV wall thickening (⌬WT) and stroke volume (⌬SV) after ME. At postmortem, a transmural "biopsy" of 1 to 2 cm 3 of embolized myocardium was imaged by micro-CT, resulting in 3D images that provided volumes and SAs of the individual nonperfused foci. Additionally, in 9 pigs, creatine phosphokinase (CK) activity in embolized myocardium was measured as an index of washout of substances from the NPM. After ME, ⌬WT, ⌬SV, and CK washout were correlated more closely with the total SA (rϭ0.95, PϽ0.001; rϭ0.68, PϽ0.01; and rϭ0.88, Pϭ0.01, respectively) than with the total NPM volume (rϭ0. 59, PϾ0.05; 0.46, PϾ0.05; and rϭ0.69, Pϭ0.04, respectively). Conclusion-After coronary ME, LV dysfunction is more closely related to the total SA than to the total volume of nonperfused microregions in the myocardium.

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Role of oxygen-derived free radicals in myocardial edema and ischemia in coronary microvascular embolization.

Abstract: Background. Oxygen-derived free radicals are thought to injure the ischemic heart during coronary microvascular embolization.

Cited by 69 publications

References 38 publications

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

Relationship between surface area of nonperfused myocardium and extravascular extraction of contrast agent following coronary microembolization

Relation of Nonperfused Myocardial Volume and Surface Area to Left Ventricular Performance in Coronary Microembolization

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