Preconditioning effect during coronary angioplasty in patients with stable angina pectoris.
OBJECTIVE
To determine whether collateral recruitment is involved in the preconditioning effect on the electrocardiogram, chest symptoms, and lactate metabolism during coronary angioplasty in patients with stable angina pectoris.


METHODS
Sixteen patients with stable angina pectoris underwent three consecutive 2-min balloon inflations 5-min apart. The greatest ST elevation (deltaSTmax), the sum of ST elevations in all leads (sum(ST)), and QT dispersion (QTd) were measured at the end of each balloon inflation. Chest pain score was evaluated on a scale ranging from no pain (0) to the most severe pain (10). Lactate extraction ratio (LER) was determined by simultaneous blood sampling from the aorta and the coronary sinus. Collateral flow index (CFI) was derived from simultaneous measurements of mean aortic pressure and coronary wedge pressure obtained from a pressure guidewire during balloon inflation.


RESULTS
Significant decreases were noted in deltaSTmax (3.3+/-2.1 vs. 3.0+/-1.9 vs. 2.6+/-1.8 mm, p<0.01), sum(ST) (9.7+/-7.2 vs. 8.5+/-6.1 vs. 6.9+/-5.3 mm, p<0.01), QTd (55.3+/-13.8 vs. 46.9+/-9.0 vs. 42.5+/-10.0 ms, p<0.01), and chest pain score (4.3+/-3.1 vs. 2.8+/-2.6 vs. 1.4+/-1.5, p<0.01) during the three sequential balloon inflations. LER significantly increased (-55.5+/-47.8 vs. -36.7+/-34.3 vs. -19.6+/-26.2%, p<0.01), indicating decreased lactate production. No significant difference was observed in CFI (0.16+/-0.10 vs. 0.15+/-0.10 vs. 0.15+/-0.10).


CONCLUSIONS
Repeated balloon inflations during coronary angioplasty elicited a preconditioning effect on ST-segment shift, QT dispersion, chest pain, and lactate production that does not involve collateral recruitment.
First Department of Internal Medicine, Hiroshima University School of Medicine.
Kenya
K
Sakai
Togo
T
Yamagata
Hiroki
H
Teragawa
Hideo
H
Matsuura
Kazuaki
K
Chayama
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003097:Collateral Circulation / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D019344:Lactic Acid / Q000097:blood / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D019344:Lactic Acid