[Pharmacologic myocardial protection during percutaneous transluminal coronary angioplasty (PTCA) by intracoronary dipyridamole: hemodynamic, contractile and dynamic ventricular consequences].
Percutaneous transluminal coronary angioplasty (PTCA) represents a suitable model to establish myocardial ischemia in man. Balloon inflation usually is accompanied by a significant deterioration in left ventricular systolic and diastolic properties. A brief episode of ischemia followed by reperfusion termed preconditioning has been identified as a mechanism rendering the myocardium more resistant to ischemia. Adenosine is considered as important mediator of preconditioning. Dipyridamole represents an important drug interfering with myocardial adenosine metabolism by inhibiting its cellular reuptake. The aim of this study was to investigate if an intracoronary infusion of dipyridamole represents a suitable tool in preventing the deterioration of left ventricular performance and hemodynamics during PTCA. In 20 patients undergoing elective coronary angioplasty of a major vessel assessment of angiographic left ventricular performance and left ventricular hemodynamics was performed before, during and after coronary angioplasty. Patients were randomly allocated to study group 1 receiving an intracoronary infusion of dipyridamole prior to PTCA and study group 2 where conventional pretreatment was performed. In study group 3 intracoronary dipyridamole infusion was performed in 10 patients with coronary artery disease during coronary angiography in order to evaluate its effect on baseline hemodynamics and left ventricular performance. Dipyridamole-pretreatment resulted in a significant preservation of systolic and diastolic left ventricular performance during PTCA, as documented by an uneffected global ejection fraction (in comparison to a deterioration of 29.2% in study group 2) and an increment in diastolic stiffness of only 12.7% (in comparison to an increment of 57.3% in study group 2). Furthermore, a significant prolongation of achievable balloon-inflation times of 48.4% could be obtained in study group 1. In addition, incidence of arrhythmias seemed to be reduced in study group 1. Apart from two cases of coronary steal phenomenon no significant side effects of dipyridamole infusion could be detected. Finally, in study group 3 dipyridamole-pretreatment per se induced a significant amelioration of angiographically assessed left ventricular systolic performance.(ABSTRACT TRUNCATED AT 400 WORDS)
Strauer
B E
BE
Medizinische Klinik und Poliklinik B Heinrich-Heine-Universität Düsseldorf.
Heidland
U E
UE
Heintzen
M P
MP
Schwartzkopff
B
B
D000241:Adenosine / Q000378:metabolism; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004176:Dipyridamole / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects* / Q000502:physiology; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000378:metabolism; D011292:Premedication; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
D014665:Vasodilator Agents; D004176:Dipyridamole; D000241:Adenosine
Pharmakologische Myokardprotektion während perkutaner transluminaler Koronarangioplastie (PTCA) durch Dipyridamol intrakoronar: hämodynamische, kontraktile und ventrikeldynamische Konsequenzen.