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Assessment of coronary reserve in man
ABSTRACTS
CARDIAC
FUNCTION IN TOTAL ANOMALOUS PULMONARY DRAINAGE (TAPvR) Rajamma Mathew, MD; Otto G. Thilenius, MD,FACC; Robert Replogle, MD; Rene A. Arcilla, MD, FACC, University of Chicago, Chicago, Illinois VENOUS
Right/left heart function was evaluated in 10 iI1fants with TAPVR. Group A(n=4; mean age-14 days) had significant pulmonary venous obstruction (PVO) and suprasystemic (113-138%) pulmonary artery pressures (PAP); group B (n-6; mean age=21 days) had subsystemic (20-80%) PAP. Surgical correction under deep hypothermia was successful in l/3 of A, and 616 of B. RV, LA and LV volumes, and related parameters, were compared with those of 10 normal infants (N). All had small LAmax (mean, 17.5 cm3/M2, 46% of N), and appendage/ cavity ratio was 0.28 (N=O.ll, p
SUSTAINEDRRMGDYRAMICEFFECTSOF NITROGLYCWIN OIlocMwT Steven C. Meister,MD,FACC; CharlesFurr,MD;Gilson Feitosa,MD;PristineBostrom,MD;William S. Fraukl,W, FACC; Toby R. Rngel,MD,MedicalCollegeof Pennsylvania, Philadelphia,Pennsylvania Intravenousvase-dilating drugs have been shown to improve the hemdynamic status of patientsin congestiveheart failure(CRP)'but requireconstanthemdynamic monitoring and precisecontrolof infusionrate. BitFoglycerin ointment 2$ (NO) was evaluatedfor sustainedhemodynamicaction in 12 patientswith CRF. One inch of IV0was applied to a 6” x 6” area under an occlusivedressing.If pulmonary wedge pressure (PWP)did not fall by 5nnnHg within 30 min., the dose and applicationarea of NO was doubled. Controlmean values - SFM were: 26.0~2.2mm~gfor PWP, 34.5f2.7mmRgfor mean pulmonaryarterypressure (PAP), 138.9fll.lnrmHg for systemicsystolicpressure(SSP), and 91.3~4.5rmnRg for systemicdiastolicpressure(SDP). Mean differencesfrom controlafter NO applicationwere: PWP PAP SSP SDP
30min -10.69.3 -9.6s.5 -11.6r4.6 -9.cTr3.4
2hr lhr -9022.4 -12.5ti.4 -9.4r2.9 -12.8r2.1 -10.8f4.2-9.023.6 -6.6t3.2 -8.722.5
3hr -12.7f1.8 -9.54.7 -15.333.2 -10.3t2.4
4hr -I2.9%7 -l2.1*.1 -17.7t3.4 -10.5f2.4
All differenceswere significantat p< .05 to < .005. Onset of significanthemodynamicactionwas at 15 min. The area of applicationwas critical,since 1 inch of NC appliedto a 3"x3" area producedno consistenthemodynamic changes.No patientsrequiredreductionof dosage because of hypotensionor other adverseeffects. ‘Fhus, NO caused significantreductionin PWP, PAP, SSP and SDP for at least 4 hrs., and may be suitablefor vasodilator therapyof CHF in ambulatorypatients.
January
COMPARATIVE EVALUATION OF POSTURAL CHANGES ON VENTRICULAR FUNCTION AND ISCHEMIA IN ACUTE MYOCARDIAL INFARCTION: SAFETY OF SITTING POSITION SHOWN BY CARDIAC CATHETERIZATION AND PRECORDIAL ST SEGMENT MAPPING Robert Merwin, MD, David 0. Williams, MD, Dennis Maddox, MD, Ezra A. Amsterdam, MD, FACC, and Dean T. Mason, MD, FACC, Martinez VA Hospital, U.C. Davis, California The effects of sequential changes in position from supine to 30" head-up and then to bedside sitting with legs dependent, on cardiac function and myocardial ischemia were assessed in twelve patients (pts) within 72 hrs of uncomplicated acute myocardial infarction (AMI). Heart rate (HR), systemic arterial pressure (AP), pulmonary artery wedge (PAW) pressure, cardiac index (CI) and ST segment mapping with 35-lead precordial blanket were evaluated 5 minutes after each position. Compared to supine, no changes occurred during head-up or sitting in AP, PAW or HR.AP product of myocardial O2 consumption index. Sequentially from supine to head-up to sitting, CI decreased (pc.02) 2.72 to 2.47 to 2.37 L/min/M* and total systemic vascular resistance rose (pc.05) 1294 to 1503 to 1510 There were no significant differences in dynes set cm-s. hemodynamic variables between head-up and sitting postures. In five pts with anterior AMI, no changes occurred in sum of ST elevations or total leads with ST elevation during the three different postures. Thus the sitting position compared to supine in the early recovery phase of AM1 is associated with relatively small hemodynamic alterations, which are not different from supine head elevation. Moreover, change from supine to bedside sitting does not produce objective evidence of extension of myocardial ischemia in uncomplicated AMI.
ASSESSMENT OF CORONARY RESERVE IN MAN Hylton I. Miller, MB; William Ganz, MD; Akira Kurita, MD; Neil Buchbinder, MD. Cedars-Sinai Medical Center, Los Angeles, California Resting coronary blood flow has not been generally useful in differentiating normal coronary arteries from coronary Stenoses of 40-80% do not reduce resting artery disease. flow, but can limit increase in flow in the artery. The purpose of the present study was, therefore, to develop a method for the assessment of the functional significance of anatomical changes in left coronary bed by measuring the response of coronary resistance and coronary blood flow to intracoronary injection of contrast medium, which was shown to cause maximum coronary vasodilation. At diagnostic coronary arteriography, coronary sinus blood flow was measured continuously by the continuous thermodilution technique before, during, and after injection of about 7 ml of contrast into the left coronary artery along Coronary reserve (R) was exwith the aortic pressure. pressed as a ratio of coronary resistance (CR)=(ABP/CSBF) before and the minimum resistance after contrast injection. Results in 9 patients with normal coronary arteries (Normal) and 23 with symptomatic coronary artery disease (CAD) with heart rates of 90 or less: Normal P Value CAD 2.9-(&D) 1.6m.26 c.001 Coronary Reserve 99+36 121237 NS 23ar43 =.OOl 176+52 .97*.19 c.001 .831-.27 control -CR .32+.06 .52+.19 <.ODl contrast Although CSBF and CR after contrast were significantly different in the 2 qroups, only coronary reserve allowed It is felt that-measurement of a complete separation. coronary reserve will be clinically helpful in the evaluation of anatomical changes in left coronary bed.
1976
The American
Journal
of CARDIOLOGY
Volume
37
155
CARDIAC
FUNCTION IN TOTAL ANOMALOUS PULMONARY DRAINAGE (TAPvR) Rajamma Mathew, MD; Otto G. Thilenius, MD,FACC; Robert Replogle, MD; Rene A. Arcilla, MD, FACC, University of Chicago, Chicago, Illinois VENOUS
Right/left heart function was evaluated in 10 iI1fants with TAPVR. Group A(n=4; mean age-14 days) had significant pulmonary venous obstruction (PVO) and suprasystemic (113-138%) pulmonary artery pressures (PAP); group B (n-6; mean age=21 days) had subsystemic (20-80%) PAP. Surgical correction under deep hypothermia was successful in l/3 of A, and 616 of B. RV, LA and LV volumes, and related parameters, were compared with those of 10 normal infants (N). All had small LAmax (mean, 17.5 cm3/M2, 46% of N), and appendage/ cavity ratio was 0.28 (N=O.ll, p
SUSTAINEDRRMGDYRAMICEFFECTSOF NITROGLYCWIN OIlocMwT Steven C. Meister,MD,FACC; CharlesFurr,MD;Gilson Feitosa,MD;PristineBostrom,MD;William S. Fraukl,W, FACC; Toby R. Rngel,MD,MedicalCollegeof Pennsylvania, Philadelphia,Pennsylvania Intravenousvase-dilating drugs have been shown to improve the hemdynamic status of patientsin congestiveheart failure(CRP)'but requireconstanthemdynamic monitoring and precisecontrolof infusionrate. BitFoglycerin ointment 2$ (NO) was evaluatedfor sustainedhemodynamicaction in 12 patientswith CRF. One inch of IV0was applied to a 6” x 6” area under an occlusivedressing.If pulmonary wedge pressure (PWP)did not fall by 5nnnHg within 30 min., the dose and applicationarea of NO was doubled. Controlmean values - SFM were: 26.0~2.2mm~gfor PWP, 34.5f2.7mmRgfor mean pulmonaryarterypressure (PAP), 138.9fll.lnrmHg for systemicsystolicpressure(SSP), and 91.3~4.5rmnRg for systemicdiastolicpressure(SDP). Mean differencesfrom controlafter NO applicationwere: PWP PAP SSP SDP
30min -10.69.3 -9.6s.5 -11.6r4.6 -9.cTr3.4
2hr lhr -9022.4 -12.5ti.4 -9.4r2.9 -12.8r2.1 -10.8f4.2-9.023.6 -6.6t3.2 -8.722.5
3hr -12.7f1.8 -9.54.7 -15.333.2 -10.3t2.4
4hr -I2.9%7 -l2.1*.1 -17.7t3.4 -10.5f2.4
All differenceswere significantat p< .05 to < .005. Onset of significanthemodynamicactionwas at 15 min. The area of applicationwas critical,since 1 inch of NC appliedto a 3"x3" area producedno consistenthemodynamic changes.No patientsrequiredreductionof dosage because of hypotensionor other adverseeffects. ‘Fhus, NO caused significantreductionin PWP, PAP, SSP and SDP for at least 4 hrs., and may be suitablefor vasodilator therapyof CHF in ambulatorypatients.
January
COMPARATIVE EVALUATION OF POSTURAL CHANGES ON VENTRICULAR FUNCTION AND ISCHEMIA IN ACUTE MYOCARDIAL INFARCTION: SAFETY OF SITTING POSITION SHOWN BY CARDIAC CATHETERIZATION AND PRECORDIAL ST SEGMENT MAPPING Robert Merwin, MD, David 0. Williams, MD, Dennis Maddox, MD, Ezra A. Amsterdam, MD, FACC, and Dean T. Mason, MD, FACC, Martinez VA Hospital, U.C. Davis, California The effects of sequential changes in position from supine to 30" head-up and then to bedside sitting with legs dependent, on cardiac function and myocardial ischemia were assessed in twelve patients (pts) within 72 hrs of uncomplicated acute myocardial infarction (AMI). Heart rate (HR), systemic arterial pressure (AP), pulmonary artery wedge (PAW) pressure, cardiac index (CI) and ST segment mapping with 35-lead precordial blanket were evaluated 5 minutes after each position. Compared to supine, no changes occurred during head-up or sitting in AP, PAW or HR.AP product of myocardial O2 consumption index. Sequentially from supine to head-up to sitting, CI decreased (pc.02) 2.72 to 2.47 to 2.37 L/min/M* and total systemic vascular resistance rose (pc.05) 1294 to 1503 to 1510 There were no significant differences in dynes set cm-s. hemodynamic variables between head-up and sitting postures. In five pts with anterior AMI, no changes occurred in sum of ST elevations or total leads with ST elevation during the three different postures. Thus the sitting position compared to supine in the early recovery phase of AM1 is associated with relatively small hemodynamic alterations, which are not different from supine head elevation. Moreover, change from supine to bedside sitting does not produce objective evidence of extension of myocardial ischemia in uncomplicated AMI.
ASSESSMENT OF CORONARY RESERVE IN MAN Hylton I. Miller, MB; William Ganz, MD; Akira Kurita, MD; Neil Buchbinder, MD. Cedars-Sinai Medical Center, Los Angeles, California Resting coronary blood flow has not been generally useful in differentiating normal coronary arteries from coronary Stenoses of 40-80% do not reduce resting artery disease. flow, but can limit increase in flow in the artery. The purpose of the present study was, therefore, to develop a method for the assessment of the functional significance of anatomical changes in left coronary bed by measuring the response of coronary resistance and coronary blood flow to intracoronary injection of contrast medium, which was shown to cause maximum coronary vasodilation. At diagnostic coronary arteriography, coronary sinus blood flow was measured continuously by the continuous thermodilution technique before, during, and after injection of about 7 ml of contrast into the left coronary artery along Coronary reserve (R) was exwith the aortic pressure. pressed as a ratio of coronary resistance (CR)=(ABP/CSBF) before and the minimum resistance after contrast injection. Results in 9 patients with normal coronary arteries (Normal) and 23 with symptomatic coronary artery disease (CAD) with heart rates of 90 or less: Normal P Value CAD 2.9-(&D) 1.6m.26 c.001 Coronary Reserve 99+36 121237 NS 23ar43 =.OOl 176+52 .97*.19 c.001 .831-.27 control -CR .32+.06 .52+.19 <.ODl contrast Although CSBF and CR after contrast were significantly different in the 2 qroups, only coronary reserve allowed It is felt that-measurement of a complete separation. coronary reserve will be clinically helpful in the evaluation of anatomical changes in left coronary bed.
1976
The American
Journal
of CARDIOLOGY
Volume
37
155