Physiological Impact of Afterload Reduction on Cardiac Mechanics and Coronary Hemodynamics Following Isosorbide Dinitrate Administration in Ischemic Heart Disease

Tiffany Patterson*, Simone Rivolo, Daniel Burkhoff, Jan Schreuder, Natalia Briceno, Christopher Allen, Rupert Williams, Satpal Arri, Kaleab N. Asrress, Jubin Joseph, Hannah Z.R. McConkey, Howard Ellis, Antonis Pavlidis, Brian Clapp, Divaka Perera, Jack Lee, Michael S. Marber, Simon R. Redwood

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
16 Downloads (Pure)

Abstract

Understanding the cardiac-coronary interaction is fundamental to developing treatment strategies for ischemic heart disease. We sought to examine the impact of afterload reduction following isosorbide dinitrate (ISDN) administration on LV properties and coronary hemodynamics to further our understanding of the cardiac-coronary interaction. Novel methodology enabled real-time simultaneous acquisition and analysis of coronary and LV hemodynamics in vivo using coronary pressure-flow wires (used to derive coronary wave energies) and LV pressure-volume loop assessment. ISDN administration resulted in afterload reduction, reduced myocardial demand, and increased mechanical efficiency (all P<0.01). Correlations were demonstrated between the forward compression wave (FCW) and arterial elastance (r=0.6) following ISDN. In the presence of minimal microvascular resistance, coronary blood flow velocity exhibited an inverse relationship with LV elastance. In summary this study demonstrated a reduction in myocardial demand with ISDN, an inverse relationship between coronary blood flow velocity and LV contraction-relaxation and a direct correlation between FCW and arterial elastance. Graphical abstract: The pressure volume-loop and corresponding parameters b The pressure volume loop before (solid line) and after (broken line) Isosorbide dintrate [Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)962-974
Number of pages13
JournalJournal of Cardiovascular Translational Research
Volume14
Issue number5
Early online date15 Mar 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
Cardiovascular Research Department, Guy?s and St Thomas Hospital

Publisher Copyright:
© 2021, The Author(s).

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