Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1995 Sep;74(3):242–246. doi: 10.1136/hrt.74.3.242

Diastolic aortic pressure rise during percutaneous transluminal coronary angioplasty: an index of left ventricular systolic dysfunction.

I A Paraskevaidis 1, Z S Kyriakides 1, A K Kassimatis 1, T P Apostolou 1, G K Kalopisis 1, D T Kremastinos 1
PMCID: PMC484013  PMID: 7547017

Abstract

OBJECTIVES--To investigate the relation between diastolic aortic pressure response and left ventricular systolic dysfunction during percutaneous transluminal coronary angioplasty. BACKGROUND--The abnormal diastolic blood pressure rise during exercise in patients with coronary artery disease probably reflects left ventricular systolic dysfunction rather than the number of stenosed coronary arteries. METHODS--Aortic blood pressures and left ventricular systolic function indices were estimated in 26 patients with single proximal stenosis of the left anterior descending coronary artery both before and during angioplasty. RESULTS--During coronary angioplasty all patients presented an increase in diastolic aortic pressure (P << 0.001), 8-12s before intracoronary electrocardiographic changes. During acute ischaemia there was a decrease in left ventricular ejection fraction (P << 0.001) and stroke volume (P << 0.001) and an increase in end systolic volume (P << 0.001) and left ventricular end diastolic pressure (P << 0.001). No statistically significant changes were observed in systolic blood pressure or heart rate. The aortic diastolic pressure increase was correlated with the decrease in ejection fraction (r = -0.95, P << 0.001) and with the increases in end systolic volume (r = 0.86, P << 0.001) and left ventricular end diastolic pressure (r = 0.85, P << 0.001). CONCLUSIONS--The rise in diastolic aortic pressure during percutaneous transluminal coronary angioplasty occurs earlier than intracoronary electrocardiographic changes and is related to ischaemic left ventricular systolic dysfunction.

Full text

PDF
242

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akhras F., Jackson G. Raised exercise diastolic blood pressure as indicator of ischaemic left ventricular dysfunction. Lancet. 1991 Apr 13;337(8746):899–900. doi: 10.1016/0140-6736(91)90216-c. [DOI] [PubMed] [Google Scholar]
  2. Bertrand M. E., Lablanche J. M., Fourrier J. L., Traisnel G., Mirsky I. Left ventricular systolic and diastolic function during acute coronary artery balloon occlusion in humans. J Am Coll Cardiol. 1988 Aug;12(2):341–347. doi: 10.1016/0735-1097(88)90403-2. [DOI] [PubMed] [Google Scholar]
  3. Carlson E. B., Cowley M. J., Wolfgang T. C., Vetrovec G. W. Acute changes in global and regional rest left ventricular function after successful coronary angioplasty: comparative results in stable and unstable angina. J Am Coll Cardiol. 1989 May;13(6):1262–1269. doi: 10.1016/0735-1097(89)90298-2. [DOI] [PubMed] [Google Scholar]
  4. Chierchia S., Brunelli C., Simonetti I., Lazzari M., Maseri A. Sequence of events in angina at rest: primary reduction in coronary flow. Circulation. 1980 Apr;61(4):759–768. doi: 10.1161/01.cir.61.4.759. [DOI] [PubMed] [Google Scholar]
  5. Coote J. H., Hilton S. M., Perez-Gonzalez J. F. The reflex nature of the pressor response to muscular exercise. J Physiol. 1971 Jul;215(3):789–804. doi: 10.1113/jphysiol.1971.sp009498. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Emanuelsson H., Holmberg S., Selin K., Wallin J. Factors that modify the flow response to intracoronary injections. Circulation. 1985 Aug;72(2):287–291. doi: 10.1161/01.cir.72.2.287. [DOI] [PubMed] [Google Scholar]
  7. Gault J. H., Ross J., Jr, Braunwald E. Contractile state of the left ventricle in man: instantaneous tension-velocity-length relations in patients with and without disease of the left ventricular myocardium. Circ Res. 1968 Apr;22(4):451–463. doi: 10.1161/01.res.22.4.451. [DOI] [PubMed] [Google Scholar]
  8. Guyton A. C. The relationship of cardiac output and arterial pressure control. Circulation. 1981 Dec;64(6):1079–1088. doi: 10.1161/01.cir.64.6.1079. [DOI] [PubMed] [Google Scholar]
  9. Jaffe C. C., Wohlgelernter D., Cabin H., Bowman L., Deckelbaum L., Remetz M., Cleman M. Preservation of left ventricular ejection fraction during percutaneous transluminal coronary angioplasty by distal transcatheter coronary perfusion of oxygenated Fluosol DA 20%. Am Heart J. 1988 Jun;115(6):1156–1164. doi: 10.1016/0002-8703(88)90002-6. [DOI] [PubMed] [Google Scholar]
  10. Kass D. A., Marino P., Maughan W. L., Sagawa K. Determinants of end-systolic pressure-volume relations during acute regional ischemia in situ. Circulation. 1989 Dec;80(6):1783–1794. doi: 10.1161/01.cir.80.6.1783. [DOI] [PubMed] [Google Scholar]
  11. Kass D. A., Midei M., Brinker J., Maughan W. L. Influence of coronary occlusion during PTCA on end-systolic and end-diastolic pressure-volume relations in humans. Circulation. 1990 Feb;81(2):447–460. doi: 10.1161/01.cir.81.2.447. [DOI] [PubMed] [Google Scholar]
  12. Little W. C., O'Rourke R. A. Effect of regional ischemia on the left ventricular end-systolic pressure-volume relation in chronically instrumented dogs. J Am Coll Cardiol. 1985 Feb;5(2 Pt 1):297–302. doi: 10.1016/s0735-1097(85)80050-4. [DOI] [PubMed] [Google Scholar]
  13. McCloskey D. I., Mitchell J. H. Reflex cardiovascular and respiratory responses originating in exercising muscle. J Physiol. 1972 Jul;224(1):173–186. doi: 10.1113/jphysiol.1972.sp009887. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mohr R., Rath S., Meir O., Smolinsky A., Har-Zahav Y., Neufeld H. N., Goor D. A. Changes in systemic vascular resistance detected by the arterial resistometer: preliminary report of a new method tested during percutaneous transluminal coronary angioplasty. Circulation. 1986 Oct;74(4):780–785. doi: 10.1161/01.cir.74.4.780. [DOI] [PubMed] [Google Scholar]
  15. Morris S. N., Phillips J. F., Jordan J. W., McHenry P. L. Incidence and significance of decreases in systolic blood pressure during graded treadmill exercise testing. Am J Cardiol. 1978 Feb;41(2):221–226. doi: 10.1016/0002-9149(78)90160-1. [DOI] [PubMed] [Google Scholar]
  16. Paraskevaidis I. A., Kremastinos D. T., Kassimatis A. S., Karavolias G. K., Kordosis G. D., Kyriakides Z. S., Toutouzas P. K. Increased response of diastolic blood pressure to exercise in patients with coronary artery disease: an index of latent ventricular dysfunction? Br Heart J. 1993 Jun;69(6):507–511. doi: 10.1136/hrt.69.6.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sanders J. S., Ferguson D. W. Diastolic pressure determines autonomic responses to pressure perturbation in humans. J Appl Physiol (1985) 1989 Feb;66(2):800–807. doi: 10.1152/jappl.1989.66.2.800. [DOI] [PubMed] [Google Scholar]
  18. Serruys P. W., Wijns W., van den Brand M., Meij S., Slager C., Schuurbiers J. C., Hugenholtz P. G., Brower R. W. Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty. Circulation. 1984 Jul;70(1):25–36. doi: 10.1161/01.cir.70.1.25. [DOI] [PubMed] [Google Scholar]
  19. Sheps D. S., Ernst J. C., Briese F. W., Myerburg R. J. Exercise-induced increase in diastolic pressure: indicator of severe coronary artery disease. Am J Cardiol. 1979 Apr;43(4):708–712. doi: 10.1016/0002-9149(79)90067-5. [DOI] [PubMed] [Google Scholar]
  20. Smith E. E., Guyton A. C., Manning R. D., White R. J. Integrated mechanisms of cardiovascular response and control during exercise in the normal human. Prog Cardiovasc Dis. 1976 May-Jun;18(6):421–444. doi: 10.1016/0033-0620(76)90010-4. [DOI] [PubMed] [Google Scholar]
  21. Verani M. S., Lacy J. L., Guidry G. W., Nishimura S., Mahmarian J. J., Athanasoulis T., Roberts R. Quantification of left ventricular performance during transient coronary occlusion at various anatomic sites in humans: a study using tantalum-178 and a multiwire gamma camera. J Am Coll Cardiol. 1992 Feb;19(2):297–306. doi: 10.1016/0735-1097(92)90482-3. [DOI] [PubMed] [Google Scholar]
  22. Weber K. T., Janicki J. S., Hunter W. C., Shroff S., Pearlman E. S., Fishman A. P. The contractile behavior of the heart and its functional coupling to the circulation. Prog Cardiovasc Dis. 1982 Mar-Apr;24(5):375–400. doi: 10.1016/0033-0620(82)90020-2. [DOI] [PubMed] [Google Scholar]
  23. Wohlgelernter D., Jaffe C. C., Cabin H. S., Yeatman L. A., Jr, Cleman M. Silent ischemia during coronary occlusion produced by balloon inflation: relation to regional myocardial dysfunction. J Am Coll Cardiol. 1987 Sep;10(3):491–498. doi: 10.1016/s0735-1097(87)80189-4. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES