94 Flow-Contraction Matching in The Human Heart: A Novel Invasive Study of The Complex Cardiac-Coronary Interaction in Ischaemic Heart Disease
HEART(2016)
摘要
Background A first-in-human study of simultaneous invasive real-time left ventricular (LV) and coronary haemodynamics in the cardiac catheter lab enabling accurate delineation of the complex cardiac-coronary interaction and influence of antianginal therapy in coronary artery disease (CAD). Method 15 patients completed the protocol (Figure;AB (paired t-test; linear regression). Results Accurate delineation and timings of the backward and forward waves were described relative to cardiac contraction and relaxation (F). Backward expansion wave (BEW) occurred during isovolumic relaxation and correlated for the first time with peak dpdt- (r 2 0.4 p = 0.0015) and found to be load dependent (F); forward compression wave (FCW) occurred immediately following peak dpdt+; ISDN drove leftward, downward shift of PV loop (D) accompanied by two-step cardiovascular response 1) significant afterload reduction (endsystolic pressure 127+/-±23;98±22 mmHg; p Conclusion For the first time in humans we relate coronary flow to cardiac contraction-relaxation and describe how ISDN exerts an anti-anginal effect by reduction in afterload and preload, therefore cardiac work and improved cardiac efficiency, maintaining coronary flow despite reduction in perfusion pressure, thus vastly increasing our understanding of the integrated cardiovascular response.
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