Paradoxical increase in microvascular resistance during tachycardia downstream from a severe stenosis in patients with coronary artery disease: reversal by angioplasty (Articolo in rivista)

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  • Paradoxical increase in microvascular resistance during tachycardia downstream from a severe stenosis in patients with coronary artery disease: reversal by angioplasty (Articolo in rivista) (literal)
Anno
  • 2001-01-01T00:00:00+01:00 (literal)
Alternative label
  • Sambuceti G.*, Marzilli M.*, Fedele S.*, Marini C.*, L'Abbate A. * ** (2001)
    Paradoxical increase in microvascular resistance during tachycardia downstream from a severe stenosis in patients with coronary artery disease: reversal by angioplasty
    in Circulation (N.Y.N.Y.)
    (literal)
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  • Sambuceti G.*, Marzilli M.*, Fedele S.*, Marini C.*, L'Abbate A. * ** (literal)
Pagina inizio
  • 2352 (literal)
Pagina fine
  • 2360 (literal)
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  • The paper is published in one of the leading journal in cardiology. (Impact Factor 2001: 10.517) (literal)
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  • 103 (literal)
Rivista
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  • IF 10517 (literal)
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  • The relevance of this paper stands on the clinical documentation of coronary microvascular vasoconstriction during myocardial ischemia. Results of this study challenge the traditional model of vascular control of myocardial blood flow and lead to the novel hypothesis of an endothelial control of intravascular pressure opposite to the classical myogenic “reflex”. Such an hypothesis is confirmed by ongoing experiments on isolated heart perfused at different pressure regimen. (literal)
Note
  • ISI Web of Science (WOS) (literal)
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  • * CNR Institute of Clinical Physiology and **The Sant'Anna School of Advanced Studies, Pisa, Italy (literal)
Titolo
  • Paradoxical increase in microvascular resistance during tachycardia downstream from a severe stenosis in patients with coronary artery disease: reversal by angioplasty (literal)
Abstract
  • BACKGROUND: The pathophysiology of microvascular response to a severe coronary stenosis has not been conclusively identified. The aim of this study was to characterize the human vasomotor response to pacing-induced ischemia of both the stenotic arterial segment and the distal microcirculation. METHODS AND RESULTS: Sixteen patients with stable angina and single-vessel disease were studied. Blood flow velocity and transstenotic pressure gradient were monitored at baseline, after intracoronary adenosine (2 mg), and during ischemia induced by atrial pacing with and without adenosine. At the end of this protocol, the study was repeated after intracoronary phentolamine in 7 patients and after angioplasty in 9. Stenosis resistance was calculated as the ratio between mean pressure gradient and mean flow, and microvascular resistance as the ratio between mean distal pressure and mean flow; values were expressed as percent of baseline. Adenosine decreased (P<0.05) baseline microvascular resistance to 52+/-17%, but not stenosis resistance. Pacing increased both stenosis and microvascular resistances (244+/-96% and 164+/-60% of baseline, respectively, P<0.05). Addition of adenosine to pacing decreased both stenosis (143+/-96% of baseline, P<0.05 versus ischemia) and microvascular (51+/-17% of baseline, P<0.05 versus baseline and ischemia) resistances. Phentolamine did not affect coronary resistance at any step of the protocol. Angioplasty and stenting restored a progressive decline in microvascular resistance during pacing (51+/-19% of baseline, P<0.05 versus baseline). CONCLUSIONS: In patients with coronary artery disease, tachycardia-induced ischemia was associated with elevated resistance of both the stenotic segment and the microvasculature. Revascularization prevents this paradoxical behavior. (literal)
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