Effect of adjunctive intracoronary adenosine on myocardial ischemia, hemodynamic function and left ventricular performance during percutaneous transluminal coronary angioplasty: clinical access to ischemic preconditioning?
BACKGROUND
Ischemic preconditioning has been defined as a mechanism that renders the heart more resistant to subsequent ischemia. Adenosine plays an important role in the pathogenesis of ischemic preconditioning.


OBJECTIVE
To assess whether intracoronary administration of adenosine prevents the deterioration of left ventricular performance and hemodynamic function by allowing adaptation to myocardial ischemia in the setting of percutaneous transluminal coronary angioplasty (PTCA).


METHODS
This was a prospectively randomized doubly blinded trial.


METHODS
We investigated 20 patients undergoing PTCA of the left anterior descending coronary artery supplying myocardium with normal left ventricular function in the setting of stable angina pectoris. Patients were randomly allocated to be administered adenosine intracoronarily (20 mg/10 min) or an equal amount of saline, providing a control population. Results of standardized chest pain questionnaires, tolerated inflation times, ST-segment shifts, left ventricular and aortic pressures, isovolumetric phase indexes, and indexes of volume and ejection fraction during the course of PTCA between the two groups were compared.


RESULTS
Patients administered adenosine tolerated significantly longer balloon-inflation times (188 +/- 41 versus 153 +/- 36 s; P = 0.03), which were associated with less pronounced signs of ischemia, and exhibited less deterioration of isovolumetric phase indexes during PTCA. Deterioration of left ventricular ejection fraction was slightly less severe with adenosine (72 +/- 5% before PTCA versus 64 +/- 6% during angioplasty) than it was for the control group (71 +/- 7% before PTCA versus 60 +/- 7% during angioplasty; P = 0.11).


CONCLUSIONS
Intracoronary application of adenosine prior to coronary angioplasty increases tolerance of ischemia and prevents deterioration of left ventricular hemodynamics during ischemia. One potential explanation of these results is that induction of ischemic preconditioning took place.
Heidland
U E
UE
School of Internal Medicine, Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany. heidland@med.uni-duesseldorf.de
Heintzen
M P
MP
Michel
C J
CJ
Strauer
B E
BE
D000241:Adenosine / Q000008:administration & dosage*; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003331:Coronary Vessels; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage*; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology; D017725:Ventricular Pressure / Q000187:drug effects / Q000502:physiology
D014665:Vasodilator Agents; D000241:Adenosine