PTCA An Investigational Tool and a Non-Operative Treatment of Acute Ischemia

One: An Investigational Tool.- From in-vitro to in-vivo model.- 1. Myocardial ischemia: Early adjustment and reversibility.- Instrumentation techniques for measurements of regional myocardial function in conscious animals.- Relationship between reduction in regional blood flow and myocardial function.- Adjustment to global LV ischemia.- Adjustment to regional myocardial ischemia.- Effects of reperfusion.- Coronary artery stenosis versus coronary artery occlusion.- Enzyme leakage from ischemic myocardium.- Reperfusion injury.- Summary.- References.- 2. Early changes in wall thickness and epicardial wall motion during percutaneous transluminal coronary angioplasty in man: Similarities with in-vitro and in-vivo model.- Echocardiographic changes in wall thickness.- Changes in epicardial wall motion.- Regional marker motion.- Analysis of pressure-derived indexes during systole and diastole.- Results.- Changes in regional epicardial wall motion.- Changes in global left ventricular function.- Discussion.- Early wall motion changes during acute ischemia.- Wall motion abnormalities in chronic ischemia.- References.- 3. Early mechanical changes associated with coronary artery Occlusion.- Materials and methods.- Results.- Regional function after 30 sec coronary occlusion.- Effects of longer and shorter occlusions.- Discussion.- References.- Electrocardiographic changes.- 4. Coronary angiographic and hemodynamic determinants of ST-segment response to acute coronary occlusion.- Patient selection.- Medications.- Angioplasty procedure and measurements.- Angiography.- Results.- Angiographic correlates.- Discussion.- Quantitation of ischemia: surface versus intracoronary ECG.- Use of the model in evaluating drug therapy.- Conclusion.- References.- 5. Dynamic appearance of collaterals during coronary occlusion and their impact on electrocardiographic changes and wall motion abnormalities.- Methods.- Study patients.- Cardiac catheterization and angioplasty protocol.- Results.- Discussion.- References.- Role of collaterals during PTCA.- 6. Collaterals and coronary wedge pressure.- Assessment of coronary collateral circulation.- Coronary wedge pressure: Definition and determinants.- Coronary wedge pressure and angiographic extent of collaterals.- Coronary wedge pressure and left ventricular function.- Coronary wedge pressure and restenosis after PTCA.- Conclusions.- References.- Coronary flow and flow reserve.- 7. Intracoronary blood flow velocity, reactive hyperemia and coronary blood flow reserve during and following PTCA.- Patients and methods.- Intracoronary blood flow velocity measurements.- Protocol.- Quantitative analysis of the coronary artery.- Protocol of the investigational procedure.- Coronary flow reserve measurements with digital subtraction cineangiography.- Results.- The first study group: Coronary blood flow velocity during PTCA as a guide line for assessment of the functional results.- Second study group: A comparison of two methods to measure coronary flow reserve in the setting of coronary angioplasty: intracoronary blood flow velocity measurements with a Doppler catheter, and digital subtraction cineangiography.- Discussion.- Intracoronary blood flow velocity: An on line assessement of the functional result of the dilatation?.- Peak reactive hyperemia a useful functional guide line during the procedure H2 Rationale for comparison of the two techniques to measure coronary flow reserve.- Maximal coronary blood flow after pharmacological vasodilation versus reactive hyperemia induced by coronary occlusion.- Limitations.- Coronary flow reserve immediately after PTCA.- Acknowledgements.- References.- Myocardial metabolism.- 8. Loss of hydrogen and potassium ions after short periods of myocardial ischaemia in man.- Measurement of arterio-venous differences.- Oxygen.- Potassium.- Hydrogen.- Other effects of angioplasty.- A unifying hypothesis.- References.- 9. Myocardial release of hypoxanthine and lactate during coronary angioplasty: A quickly reversible phenomenon, but for how long?.- Patients and methods.- PTCA technique.- Lactate measurements.- Hypoxanthine determination.- Flow measurements.- Statistical analysis.- Results.- Coronary hemodynamic measurements.- Lactate and hypoxanthine metabolism.- Discussion.- Use of purine release as a marker for ischemia during transluminal occlusion in man.- Metabolism during reperfusion.- Summary.- References.- 10. Myocardial release of hypoxanthine and urate during angioplasty: Potential mechanism for free radical generation.- Methods.- Patients.- Assays.- Results.- Discussion.- Acknowledgements.- References.- 11. Regional myocardial nitrogen-13-glutamate uptake following successful coronary angioplasty.- Patients and methods.- Results and discussion.- References.- Myocardial function.- 12. Left atrial function in acute transient ischemia on the left ventricle.- Patients and methods.- Results.- Discussion.- References.- 13. Left ventricular filling during acute ischemia.- Methods.- Results.- Left ventricular relaxation.- Left ventricular stiffness.- Left atrial contraction.- Discussion and conclusions.- References.- 14. Left ventricular function during acute coronary artery balloon occlusion in humans.- Methods.- Assessment of chamber and myocardial stiffness constants.- Assessment of time constants of relaxation.- Statistical analysis.- Results.- Left ventricular volumes and ejection fraction.- Time constants of relaxation (?W, ?M).- Chamber stiffness constant (?).- Myocardial stiffness constants k, ß, ?.- Discussion.- Appendix 1: Rationale for the development of simple indices of chamber and myocardial stiffness.- Appendix 2: Alternative evaluation of myocardial stiffness constants.- Appendix 3: Evaluation of the time constant ?M.- References.- 15. Use of intravenous DSA in the assessment of LV performance during PTCA.- Patients.- Methods.- Results.- Discussion.- Acknowledgement.- References.- 16. Two dimensional echocardiography during PTCA.- Incidence and time course of asynergy during PTCA.- Global left ventricular function and myocardial risk area.- Left ventricular size changes.- Sequence of ischemic symptoms.- References.- 17. Doppler echocardiographic assessment of left ventricular function during PTCA.- Methods.- Results.- Systolic function.- Diastolic function.- Clinical variables.- Effects of collateral circulation.- Diastolic filling later after balloon occlusion.- Effect of diltiazem on Doppler-echocardiographic measurements.- Discussion.- Temporal sequence of ventricular dysfunction.- Comparison with previous studies.- Acknowledgements.- References.- 18. Ejection filling and diastasis during transluminal occlusion in man: Consideration on global and regional left ventricular function.- Study population and protocol.- Methods.- Analysis of pressure derived indices during systole and diastole.- Analysis of regional and global left ventricular function.- Results.- Global left ventricular function during systole and diastole.- Regional indexes of left ventricular ejection and filling and region: pressure-radius length relations.- Regional pressure-radius length relation.- Discussion.- Myocardial ischemia, transient asynergy and altered relaxation.- Uncoordinated segmental contraction as a cause of impaired filling dynamics.- Effect of coronary occlusion on left ventricular chamber stiffness and regional diastolic pressure-radius relations.- Significance of the upward shift in pressure-volume and pressure-radius relations.- Comparison with animal models of acute low-flow ischemia.- Conclusion: PTCA as an ischemic model?.- Early wall motion during acute ischemia: how to interpret?.- Are there clinical implications in chronic ischemia?.- Are there clinical implications for the PTCA procedure?.- Acknowledgement.- References.- Therapeutic effects.- 19. Myocardial ischemia during PTCA: Consequences and treatment strategies.- Consequences of balloon induced coronary occlusion.- Electrocardiographic changes.- Left ventricular functional changes.- Pharmacologic agents designed to protect the ischemic myocardium.- Nitroglycerin.- Beta adrenergic blocking agents.- Calcium channel antagonists.- Oxygenated fluorocarbons.- Mechanical devices used to limit ischemia during balloon angioplasty.- Intraaortic balloon counterpulsation.- Coronary sinus retroperfusion.- Distal hemoperfusion catheter devices.- Percutaneous cardiopulmonary bypass support.- References.- 20. Does Diltiazem protect the ischemic myocardium during PTCA?.- Methods and material.- Results.- Discussion.- References.- 21. Influence of anti-ischemic drug treatment on the ischemic response to acute coronary occlusion in man.- Patients and methods.- Results.- Nitroglycerin, hemodynamics and electrocardiogram.- Calciumantagonists, hemodynamics and electrocardiogram.- Digital angiograms.- Discussion.- Clinical implications.- References.- 22. Cardioprotective effects of coronary sinus retroperfusion during LAD angioplasty.- Methods.- Patients’ selection.- Retroperfusion systein.- Protocol.- Electrocardiographic recording.- Echocardiography.- Statistics.- Results.- Discussion.- Conclusion.- Acknowledgements.- References.- Two: Non-Operative Treatment of Acute Ischemia.- 23. Coronary angioplasty for unstable angina pectoris.- Classification of patients with unstable angina pectoris.- Pathophysiology of unstable angina and the impact of coronary angioplasty.- Coronary angioplasty in patients with ‘stabilized’ unstable angina.- Coronary angioplasty for refractory unstable angina.- Coronary angioplasty for early postinfarction angina.- Coronary angioplasty for variant angina.- Coronary angioplasty of only the culprit lesion in patients with unstable angina and multivessel disease.- Thrombolytics in the treatment of unstable angina.- Restenosis after coronary angioplasty in patients with unstable angina.- Proposed management of patients with unstable angina.- References.- 24. Coronary angioplasty in patients with non-Q wave myocardial infarction.- Natural history.- Pathogenesis.- Angiographic findings.- Therapeutic implications.- Conclusion.- References.- 25. Thrombolytic therapy and PTCA in acute myocardial thrombosis.- Coronary patency after thrombolysis and PTCA.- Infarct size and left ventricular function after thrombolysis and PTCA.- Clinical course and survival after thrombolysis and PTCA.- Immediate PTCA: a reappraisal.- Systematic delayed PTCA.- The treatment strategy in acute myocardial infarction.- References.- 26. The United States thrombolysis and angioplasty trials for acute myocardial infarction.- Pilot study.- Thrombolysis and angioplasty in myocardial infarction (TAMI).- Thrombolysis resistant group.- Randomized patients.- Patients unsuitable for randomization.- TIMI phase II.- The Johns Hopkins trial.- TAMI phase-II.- The role of angioplasty in myocardial infarction.- Direct angioplasty.- Immediate angioplasty.- Influence of the thrombolytic agent.- Early angiography and rescue angioplasty.- Conclusions drawn from the clinical trials.- References.