Key result
In dogs with severe coronary stenosis, administration of adenosine and dipyridamole induced subendocardial ischemia, evidenced by significant ST segment elevation in the inner myocardial layer.
Why the study?
Does intracoronary administration of adenosine or dipyridamole induce subendocardial ischemia in dogs with severe proximal coronary artery stenosis?
Does intracoronary administration of adenosine or dipyridamole induce subendocardial ischemia in dogs with severe proximal coronary artery stenosis?
p-value: p=<0.001
Distal vasodilatory stimuli like adenosine and dipyridamole can induce transmural flow redistribution and subendocardial ischemia in the presence of severe coronary stenosis.
Warrants caution with vasodilators in severe stenosis; leaves open human translation and needs clinical studies.
This study was designed to determine how distal vasodilatory stimuli can alter coronary hemodynamics and the appearance of myocardial ischemia in the presence of severe coronary stenosis. In anesthetized open chest dogs, left circumflex coronary artery (LCx) flow, distal LCx perfusion pressure (DCPP), heart rate, and aortic pressure were monitored and regional myocardial ischemia was estimated from ST segment deviation in the epicardial and intramyocardial electrograms obtained from the electrodes located in the area supplied by LCx. In the presence of severe LCx constriction, intracoronary administration of adenosine (0.01 mg/Kg/min) and dipyridamole (0.05 mg/Kg) failed to augment LCx flow and induced further reduction in DCPP without changing systemic hemodynamics. In parallel with these hemodynamic changes, significant ST elevation was observed in the inner layer of the area supplied by the LCx. These results show that subepicardial vasodilation following vasodilatory stimuli can induce transmural flow redistribution and lead to subendocardial ischemia in the presence of severe coronary stenosis.
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Kawashima et al. (1982) studied Severe coronary stenosis (experimental model) (n=26). Adenosine and Dipyridamole vs. Pre-infusion baseline was evaluated on Peak ST segment elevation in the inner myocardial layer (mV) for adenosine (p=<0.001). In dogs with severe coronary stenosis, administration of adenosine and dipyridamole induced subendocardial ischemia, evidenced by significant ST segment elevation in the inner myocardial layer.
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