Open AccessAttenuation of nitroglycerin‐induced coronary hyperemic blood flow in patients with left anterior descending coronary collaterals
Author(s) -
Kern M. J.,
Miller J. T.,
Henry R. L.
Publication year - 1987
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960100910
Subject(s) - medicine , cardiology , hemodynamics , blood flow , coronary arteries , artery , thrombolysis , coronary circulation , coronary occlusion , great cardiac vein , occlusion , bolus (digestion) , anesthesia , myocardial infarction
Abstract Although intracoronary nitroglycerin (NTG) is frequently administered to patients having occluded coronary arteries undergoing invasive procedures such as percutaneous transluminal coronary angioplasty or thrombolysis, the extent of NTG‐induced augmentation of myocardial blood flow in patients with collaterally filled occluded arteries is incompletely understood. To examine NTG‐induced increases in coronary blood flow in patients with occluded left anterior descending coronary arteries (LAD), coronary and systemic hemodynamics were measured during bolus administration of NTG into the left coronary artery in 10 patients with normal LAD (Group 1), 11 patients with >70% and <100% narrowing of the LAD (Group 2), and 10 patients who had total occlusion of the LAD with angiographic collateral filling and anterior ventricular wall motion abnormalities (Group 3). NTG increased anterior regional great vein flow (thermodilution) from 72±19 to 140±60 ml/min (p< 0.05), 67 ± 27 to 108±66 ml/min (p< 0.05), and 59±27 to 74±36 ml/min (p = NS vs. control, p< 0.05 vs. peak flow for Group 1) with relative increases from control of 91±41%, 56±34%, and 25±22% for the three groups, respectively. The percent change for Group 3 was significantly lower than both Groups 1 (p< 0.01) and 2 (p< 0.05). These data indicate that myocardial hyperemic blood flow responses to intracoronary NTG are markedly attenuated in patients with occluded but collaterally supplied vessels. During invasive procedures in these patients, although significantly attenuated, intracoronary NTG may potentially provide a beneficial effect by augmenting blood flow through collaterals or in adjacent regions.