Different mechanisms of ischemic adaptation to repeated coronary occlusion in patients with and without recruitable collateral circulation

Yasuhiko Sakata, Kazuhisa Kodama, Masafumi Kitakaze, Tohru Masuyama, Atsushi Hirayama, Young Jae Lim, Fuminobu Ishikura, Akihiko Sakai, Takayoshi Adachi, Masatsugu Hori

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)

Abstract

Objectives. The aim of this study was to investigate the interaction between ischemic preconditioning (IP) and collateral recruitment (CR) during ischemic adaptation in patients. Background. The mechanism of ischemic adaptation still remains controversial in humans. Methods. The clinical, electrocardiographic, hemodynamic and echocardiographic responses to three 150-s occlusions of the left anterior descending coronary artery were assessed in relation to CR in 18 patients with effort angina undergoing elective percutaneous transluminal coronary angioplasty. Results. During the first occlusion, recruitable collateral circulation (RCC) to the occluded myocardium was detected by myocardial contrast echocardiography in 6 patients (Group C) and was not seen in 12 (Group N). In Group N, all patients manifested signs of severe ischemia during each inflation. However, their symptoms and ST segment shift significantly decreased from the first to the third occlusions, suggesting the occurrence of IP. The elevation of mean pulmonary artery pressure and deterioration of anterior wall motion were comparable between the first and the third occlusions in Group N. In contrast, myocardial ischemia was significantly less marked during occlusion in Group C that in Group N, and no preconditioning effect was observed. The extent of RCC did not differ between the first and the third occlusions in each group. Conclusions. Both IP and CR may play independent roles in ischemic adaptation in humans. With RCC, myocardial ischemia was greatly reduced. Without RCC, preconditioning clinically and electrocardiographically lessened myocardial ischemia but failed to preserve left ventricular function.

Original languageEnglish
Pages (from-to)1679-1686
Number of pages8
JournalJournal of the American College of Cardiology
Volume30
Issue number7
DOIs
Publication statusPublished - 1997 Dec

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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