Bradykinin-induced preconditioning in patients undergoing coronary angioplasty
Massoud A. Leesar, MD, FACCa,
Marcus F. Stoddard, MD, FACCa,
Srinivas Manchikalapudi, MDa and
Roberto Bolli, MD, FACCa
a Division of Cardiology, University of Louisville, and the Jewish Hospital Heart and Lung Institute, Louisville, Kentucky 40292, USA
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Figure 1 Individual (left panel) and average (right panel) values of ST-segment shifts on the intracoronary ECG at the end of the first, second and third balloon inflations in control and bradykinin-treated patients. In control patients, the ST-segment shifts decreased during the second and third inflations compared with the first. In contrast, in bradykinin-treated patients the ST-segment shifts were similar during all three inflations. During the first inflation, the ST-segment shift was less in bradykinin-treated compared with control patients. Values are means ± SEM.
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Figure 2 Individual (left panel) and average (right panel) values of ST-segment shifts on the surface ECG at the end of the first, second and third balloon inflations in control and bradykinin-treated patients. In control patients, the ST-segment shifts decreased during the second and third inflations compared with the first. In contrast, in bradykinin-treated patients the ST-segment shifts were similar during all three inflations. During the first inflation, the ST-segment shift was less in bradykinin-treated than in control patients. Values are means ± SEM.
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Figure 3 Individual (left panel) and average (right panel) values of chest pain score during the first, second and third balloon inflations in control and bradykinin-treated patients. In control patients, the chest pain score decreased progressively from the first to the third inflation. In contrast, in bradykinin-treated patients the chest pain score did not change significantly during the three inflations. During all three inflations, the chest pain score was significantly less in bradykinin-treated compared with control patients. Values are means ± SEM.
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Figure 4 Chordal shortening in the ischemic/reperfused LV region at baseline (before bradykinin or saline infusion), after infusion, at the end of the first, second and third balloon inflations (INFL-1, INFL-2 and INFL-3), immediately before the second and third inflations (PRE-INFL-2 and PRE-INFL-3) and 5 min after the third inflation in control and bradykinin-treated patients (n = 9 in each group). Chordal shortening was determined by quantitative two-dimensional echocardiography using the centerline method (see "Methods") and expressed as a percent of baseline values. In control patients, the decrease in chordal shortening was significantly less during the second inflation and third inflation compared with the first inflation. In contrast, in bradykinin-treated patients, chordal shortening did not change significantly during the three inflations; furthermore, during the first inflation, chordal shortenings were less in bradykinin-treated patients than in control patients. Values are means ± SEM.
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Figure 5 Individual (left panel) and average (right panel) values of coronary artery blood flow before the infusion of bradykinin (baseline), immediately after the infusion of bradykinin (BK) and 10 min after the infusion of bradykinin (post-BK). Coronary flow increased significantly during the infusion of bradykinin but returned to baseline values within 10 min after the infusion. Values are means ± SEM.
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Figure 6 Individual (left panel) and average (right panel) values of minimal luminal diameter before the infusion of bradykinin (baseline), immediately after the infusion of bradykinin (BK) and 10 min after the infusion of bradykinin (post-BK). Minimal luminal diameter increased significantly during the infusion of bradykinin but returned to baseline values within 10 min after the infusion. Values are means ± SEM.
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