Modulation of left ventricular diastolic distensibility by collateral flow recruitment during balloon coronary occlusion
Hosam A. Remah, MD*,a,
Hidetsugu Asanoi, MDa,
Shuji Joho, MDa,
Akihiko Igawa, MDa,
Tomoki Kameyama, MDa,
Takashi Nozawa, MDa and
Hiroshi Inoue, MD, FACCa
a Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan
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Figure 1 Individual diastolic P-V relations of the good collateral flow group. Seven of 10 loops obtained during BCO had an upward shift of the diastolic P-V relation, and two loops (patients TT, LAD and ON, D1 [patient initials are followed by target lesion]) showed a rightward shift along a similar diastolic P-V relation. No change in the entire P-V loop was observed in the remaining one patient (SS, LAD), who had no evidence of myocardial ischemia during BCO. With reactive hyperemia after balloon deflation all but two patients (KT, LAD and Cx and YS, Cx) showed a further upward shift of the diastolic P-V relation. Continuous line = control; dotted line = early inflation; interrupted line = immediately after deflation; D1 = first diagonal branch; Cx = left circumflex coronary artery; LAD = left anterior descending coronary artery.
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Figure 2 Individual diastolic P-V relations of the poor collateral flow group. Four patients showed a downward shift of the diastolic P-V relation (SY, LAD; SN, LAD; MS, LAD; and HK, RCA [patient initials are followed by target lesion]) during BCO, while the remaining four patients demonstrated a rightward shift along a similar diastolic P-V relation. After balloon deflation all but one patient (MS, LAD) had a parallel upward shift of the diastolic P-V relation. RCA = right coronary artery; other abbreviations as in Figure 1.
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Figure 3 Changes in LV filling pressure and extent of ischemia. For a comparable increase in the LV ESV index, min-P remained lower in the poor collateral flow group (solid squares) compared with the good collateral flow group (open circles).
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Figure 4 Simultaneous recording of Doppler coronary flow and diastolic P-V relations. A, This patient has grade III angiographic collateral recruitment during BCO. With the appearance of retrograde Doppler flow distal to the occlusion site (inflation 30 s), the diastolic P-V relation shifted upward (dotted line). B, This patient has grade 0 angiographic collateral recruitment during BCO. There was neither distal coronary Doppler flow (inflation 30 s) nor a diastolic P-V relation shift during BCO. After balloon deflation, hyperemic flow was recorded (deflation <10 s) with a concomitant parallel upward shift of diastolic P-V relations in both patients (interrupted line).
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