[Coronary collateral function evaluated by coronary hemodynamics and myocardial lactate metabolism during rapid atrial pacing].
To elucidate coronary collateral function in the ischemic myocardium, we studied coronary hemodynamics and myocardial lactate metabolism of the collateral-dependent myocardium before and during rapid atrial pacing. Subjects consisted of 38 patients who were categorized into 3 groups according to their coronary and coronary collateral arteriographic findings: 14 patients with normal coronary arteriograms (Group A), 15 with significant stenosis in the left anterior descending coronary artery (LAD) without collaterals (Group B), and 9 with LAD stenosis and collaterals (Group C). Estimates of cross-sectional area (CSA) obtained from the orthogonal coronary arteriograms, and the great cardiac vein flow (GCVF) and myocardial lactate extraction ratio (MLER) before and during rapid atrial pacing were used as parameters to evaluate coronary stenosis. The results were as follows: 1. The cross-sectional areas in Groups B and C were 86% and 91% of that in Group A, respectively. 2. In Group B, there was a good linear relationship between cross-sectional area and % delta GCVF, as shown in % delta GCVF = 2.90 + 36.22 x CSA (r = 0.61, p < 0.05). This relationship was modified in Group C, increasing % delta GCVF against CSA. 3. Myocardial lactate extraction ratio in Groups B and C decreased significantly after rapid atrial pacing, while, it remained unchanged in Group A. This ratio after rapid atrial pacing did not differ significantly between the 2 groups. 4. In 3 of 4 patients with total LAD occlusions, GCVF and anterior coronary resistance before and during rapid atrial pacing were similar to those of Group A.(ABSTRACT TRUNCATED AT 250 WORDS)
Mikuniya
A
A
Second Department of Internal Medicine, Hirosaki University School of Medicine.
Totsuka
H
H
Fujino
Y
Y
Mikami
M
M
Tamura
H
H
Sasaki
N
N
Higashiyama
A
A
Hanada
H
H
Onodera
K
K
Oike
Y
Y
D002304:Cardiac Pacing, Artificial; D003097:Collateral Circulation; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000378:metabolism* / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007773:Lactates / Q000378:metabolism*; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*
D007773:Lactates