Role of systemic arterial pressure, heart rate, and derived variables in prediction of severity of myocardial ischemia during acute coronary occlusion in anesthetized dogs.
The present study examined the postulate that the quotient of mean systemic arterial pressure and heart rate predicts the severity of myocardial ischemia during occlusion of the left anterior descending coronary artery. Studies were performed in open-chest fentanyl-anesthetized dogs before and during halothane (n = 8) or isoflurane (n = 8) anesthesia. The pressure-rate quotient (PRQ) decreased significantly in both groups during incremental increases in halothane or isoflurane to 68% and 57% of control values at 0.5 MAC and to 41% and 38% at 1.5 MAC for halothane and isoflurane, respectively. Myocardial lactate production was unchanged from the ischemic region, and no correlation between the PRQ and myocardial lactate production was observed. In contrast, heart rate correlated significantly (r = 0.376; P less than 0.05) with lactate production. The product of systolic systemic arterial pressure and heart rate (rate-pressure product) correlated with blood flow (r = 0.493; P less than 0.001) and with oxygen consumption (r = 0.571; P less than 0.001) in the normal myocardium. A weak correlation (r = 0.330; P less than 0.05) of rate-pressure product with myocardial lactate production from the ischemic region was observed. There were no correlations between the PRQ and myocardial lactate production from the ischemic region or indices of blood flow distribution (i.e., inner/outer ratio in the ischemic region or ischemic/normal ratio). The relationship of hemodynamic variables to measurements of regional myocardial metabolism was independent of background anesthetic agent of depth of anesthesia. The current data suggest that heart rate changes are weakly predictive of severity of myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)
Moore
P G
PG
Department of Anesthesiology, University of California, School of Medicine, Davis 95616.
Reitan
J A
JA
Kien
N D
ND
White
D A
DA
Safwat
A M
AM
D000758:Anesthesia; D000818:Animals; D001158:Arteries / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D001831:Body Temperature; D003327:Coronary Disease / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D003331:Coronary Vessels / Q000502:physiology; D004285:Dogs; D005260:Female; D006221:Halothane / Q000494:pharmacology; D006339:Heart Rate / Q000502:physiology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006454:Hemoglobins / Q000032:analysis; D006863:Hydrogen-Ion Concentration; D007530:Isoflurane / Q000494:pharmacology; D008297:Male; D009206:Myocardium / Q000378:metabolism; D010100:Oxygen / Q000502:physiology; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
D006454:Hemoglobins; D007530:Isoflurane; D010100:Oxygen; D006221:Halothane