Regional nonischemic performance as assessed by end-systolic measures of shortening and thickening

Department of Cardiovascular Medicine, Radcliffe Infirmary, Oxford, England.

OBJECTIVES. Nonischemic contractile segmental performance was characterized by the end-systolic pressure-length and pressure-thickness relations during regional ischemia induced by proximal left anterior descending and left circumflex coronary artery occlusions. BACKGROUND. The increases in shortening and thickening of the nonischemic myocardium during acute ischemia have been attributed to alterations in the regional loading conditions. However, it is uncertain to what extent ischemia affects the contractile performance of the nonischemic zone. METHODS. Twenty-seven beagle dogs were instrumented with sonomicrometers and micromanometer pressure gauges. End-systolic pressure-length and pressure-thickness relation data were obtained during vena cava balloon inflation. Control data were obtained in both left anterior descending and left circumflex regions. Then, in random order, either the left anterior descending or left circumflex coronary artery was occluded for 90 s, and hemodynamic and nonischemic end-systolic pressure-length and pressure-thickness data were obtained. After a 45-min recovery period, the other artery was occluded, and the same recordings were obtained. RESULTS. The end-systolic pressure-length relation exhibited variable degrees of rightward and downward shifts and the end-systolic pressure-thickness relation variable degrees of leftward and downward shifts. Left circumflex coronary artery occlusion was associated with a greater downward displacement (decreased slope) of the nonischemic end-systolic pressure-length relation than left anterior descending coronary artery occlusion. The baseline slope was the best predictor of the change in slope of the end-systolic pressure-length and pressure-thickness relations. The left circumflex coronary artery supplied a larger proportion of left ventricular myocardial mass than the left anterior descending coronary artery. CONCLUSION: Acute ischemia profoundly affects the end-systolic performance of the nonischemic segment. Furthermore, the site, and probably size, of the ischemic zone may be important determinants of nonischemic contractile performance.

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