Physiological Impact of Afterload Reduction on Cardiac Mechanics and Coronary Hemodynamics Following Isosorbide Dinitrate Administration in Ischemic Heart Disease,Journal of Cardiovascular Translational Research

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Physiological Impact of Afterload Reduction on Cardiac Mechanics and Coronary Hemodynamics Following Isosorbide Dinitrate Administration in Ischemic Heart Disease
Journal of Cardiovascular Translational Research ( IF 2.4 ) Pub Date : 2021-03-15 , DOI: 10.1007/s12265-021-10112-0
Tiffany Patterson ₁ , Simone Rivolo ₂ , Daniel Burkhoff ₃ , Jan Schreuder ₄ , Natalia Briceno ₁ , Christopher Allen ₁ , Rupert Williams ₁ , Satpal Arri ₁ , Kaleab N Asrress ₁ , Jubin Joseph ₁ , Hannah Z R McConkey ₁ , Howard Ellis ₁ , Antonis Pavlidis ₅ , Brian Clapp ₅ , Divaka Perera ₁ , Jack Lee ₂ , Michael S Marber ₁ , Simon R Redwood ₁

Affiliation

Abstract

Understanding the cardiac-coronary interaction is fundamental to developing treatment strategies for ischemic heart disease. We sought to examine the impact of afterload reduction following isosorbide dinitrate (ISDN) administration on LV properties and coronary hemodynamics to further our understanding of the cardiac-coronary interaction. Novel methodology enabled real-time simultaneous acquisition and analysis of coronary and LV hemodynamics in vivo using coronary pressure-flow wires (used to derive coronary wave energies) and LV pressure-volume loop assessment. ISDN administration resulted in afterload reduction, reduced myocardial demand, and increased mechanical efficiency (all P<0.01). Correlations were demonstrated between the forward compression wave (FCW) and arterial elastance (r=0.6) following ISDN. In the presence of minimal microvascular resistance, coronary blood flow velocity exhibited an inverse relationship with LV elastance. In summary this study demonstrated a reduction in myocardial demand with ISDN, an inverse relationship between coronary blood flow velocity and LV contraction-relaxation and a direct correlation between FCW and arterial elastance.

Graphical abstract

The pressure volume-loop and corresponding parameters b The pressure volume loop before (solid line) and after (broken line) Isosorbide dintrate

中文翻译：

在缺血性心脏病中施用硝酸异山梨酯后减少后负荷对心脏力学和冠状动脉血流动力学的生理影响

摘要

了解心脏-冠状动脉相互作用是制定缺血性心脏病治疗策略的基础。我们试图检查硝酸异山梨酯 (ISDN) 给药后后负荷减少对 LV 特性和冠状动脉血流动力学的影响，以进一步了解心脏-冠状动脉的相互作用。新的方法能够使用冠状动脉压力流量线（用于导出冠状动脉波能量）和 LV 压力容积环评估实时同时采集和分析体内冠状动脉和 LV 血流动力学。ISDN 给药导致后负荷减少、心肌需求减少和机械效率增加（所有P <0.01）。前向压缩波 (FCW) 与动脉弹性 ( r=0.6) 遵循 ISDN。在微血管阻力最小的情况下，冠状动脉血流速度与 LV 弹性呈反比关系。总之，这项研究表明 ISDN 可减少心肌需求，冠状动脉血流速度与 LV 收缩松弛之间的反比关系以及 FCW 与动脉弹性之间的直接相关性。