Contractile failure during early ischemia is driven by flow reduction rather than a drop in perfusion pressure, refuting the vascular collapse theory.
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Flow reduction, not perfusion pressure, drives early contractile dysfunction in ischemia; hypothesis-generating in animal models, does not yet inform clinical practice.
The mechanism responsible for the abrupt fall in myocardial contractile function following coronary artery obstruction is unknown. The "vascular collapse theory" hypothesizes that the fall in coronary perfusion pressure after coronary artery obstruction is responsible for contractile failure during early ischemia. To test the role of vascular collapse in downregulating myocardial contractile force at the onset of ischemia, coronary flow of isolated rat hearts was abruptly decreased by 50, 70, 85, and 100% of baseline, and subsequent changes in coronary perfusion pressure and ventricular function were recorded at 0.5-s intervals. At 1.5 s after flow reductions ranging from 50 to 100%, decreases in contractile function did not differ, although perfusion pressure varied significantly from 45 +/- 1 to 20 +/- 2 mmHg. When function fell to 50% of baseline, perfusion pressures ranged from 35 +/- 0.5 to 2.5 +/- 1 mmHg for flow reductions ranging from 50 to 100%. Identical contractile function at widely differing coronary perfusion pressures is incompatible with the vascular collapse theory.
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He et al. (1998) studied this question.
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