In vivo validation of a thermodilution method to determine regional left ventricular blood flow in patients with coronary disease.

Pepine, Carl J.; Mehta, Jayesh; Webster, Wm.; Nichols, Wilmer W.

doi:10.1161/01.cir.58.5.795

Cited by 180 publications

(26 citation statements)

References 14 publications

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“…Coronary sinus blood flow was estimated from the thermodilution curves as described by Ganz et al (18) and validated by Pepine et al (19). Four separate estimates of coronary flow were obtained during the basal period and two estimates were made every 20 min thereafter, immediately prior to obtaining coronary sinus blood samples.…”

Section: Methodsmentioning

confidence: 99%

Regulation by insulin of myocardial glucose and fatty acid metabolism in the conscious dog.

Barrett¹,

Schwartz²,

Francis³

et al. 1984

J. Clin. Invest.

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As bstract. In vivo small doses of insulin inhibit lipolysis, lower plasma FFA, and stimulate glucose disposal. Lowering of plasma FFA, either in the absence of a change in insulin or during combined hyperglycemia and hyperinsulinemia, promotes glucose uptake by heart muscle in vivo. In the isolated perfused heart, large doses of insulin directly stimulate heart glucose uptake. To assess the effect of physiological elevations of plasma insulin upon myocardial glucose and FFA uptake in vivo independent of changes in plasma substrate concentration, we measured arterial and coronary sinus concentrations ofglucose, lactate, and FFA, and coronary blood flow in conscious dogs during a 30 min basal and a 2 h experimental period employing three protocols: (a) euglycemic hyperinsulinemia (insulin clamp, n = 5), (b) euglycemic hyperinsulinemia with FFA replacement (n = 5), (c) hyperglycemic euinsulinemia (hyperglycemic clamp with somatostatin, n = 5).In group 1, hyperinsulinemia (insulin = 73±13 MU/ ml) stimulated heart glucose uptake (7.3±4.4 vs. 28.2±2.8 Mmol/min, P < 0.002), lowered plasma FFA levels by 80% (P < 0.05), and decreased heart FFA uptake (28.4±4 vs. 1.5±0.9, P < 0.01). When the fall in plasma FFA was prevented by FFA infusion (group 2), hyperinsulinemia (86 ± 10 ,U/ml) provoked a lesser (P < 0.05) stimulation of glucose uptake (A = 8.2±4.2 ,mol/min) (plasma glucose = 186±8 mg/100 ml) during somatostatin infusion resulted in only a small rise in plasma insulin (A = 12±7 ,U/ml), and although plasma FFA tended to decline, heart glucose uptake did not rise significantly (A = 5.5±3.2 Amol/min, P = NS). There was no significant change in coronary blood flow during any of the three study protocols.We conclude that, in the dog, insulin at physiologic concentrations: (a) stimulates heart glucose uptake, both directly and by suppressing the plasma FFA concentration, and (b) does not alter coronary blood flow. Hyperglycemia per se has little effect on heart glucose uptake.

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Section: Methodsmentioning

confidence: 99%

Regulation by insulin of myocardial glucose and fatty acid metabolism in the conscious dog.

Barrett¹,

Schwartz²,

Francis³

et al. 1984

J. Clin. Invest.

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“…Thermodilution is a widely used and accepted technique for measuring coronary blood flow in man [13,14,33] . However, the technique has certain limitations.…”

Section: Limitationsmentioning

confidence: 99%

Effects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting

Lilleberg

Nieminen²,

Akkila³

et al. 1998

European Heart Journal

228

118

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AimsThe aim of the study was to evaluate the effects on systemic and coronary haemodynamics and myocardial substrate utilization of a new calcium sensitizer, levosimendan, after coronary artery bypass grafting. Methods and ResultsTwenty-three low-risk patients were included in this randomized and double-blind study. They received placebo (n=8), 8 (n=8) or 24 (n=7) g . kg 1 of levosimendan after coronary artery bypass operation. Systemic and coronary sinus haemodynamics with thermodilution and myocardial substrate utilization were measured. The heart rate increased 11 beats . min 1 after the higher dose (P<0·05). Cardiac output increased by 0·7 and 1·6 l . min 1 (P<0·05 for both) after 8 and 24 g . kg 1 of levosimendan, respectively. Systemic and pulmonary vascular resistance decreased significantly after both doses. Coronary sinus blood flow increased by 28 and 42 ml/(P=0·054 for the combined effect) after the lower and higher dose, respectively. Myocardial oxygen consumption or substrate extractions did not change statistically significantly.Conclusion Despite improved cardiac performance, levosimendan did not increase myocardial oxygen consumption or change myocardial substrate utilization. Thus levosimendan has the potential to treat low cardiac output states after cardiopulmonary bypass surgery.

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“…Second, does great cardiac vein flow reflect left anterior descending arterial flow in the interior left ventricle? Pepine et al 36 found an excellent correlation between simultaneous great cardiac vein flow by thermodilution and left anterior descending bypass graft flow in man measured by an electromagnetic flow probe, with the native artery transiently occluded. Finally, do changes in venous flow characteristics occur during rapid atrial pacing?…”

mentioning

confidence: 98%

Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction.

Cannon¹,

Schenke²,

Leon³

et al. 1987

Circulation

150

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163-174, 1987. MYOCARDIAL ISCHEMIA and angina pectoris can occur in patients who have normal epicardial coronary arteries, who are normotensive, and who have no evident myocardial disease. These patients exhibit a limited coronary flow response to the stress of pacing and after administration of pharmacologic vasodilators such as dipyridamole and contrast media.1-' We have further shown in these patients that vasoconstrictor stimuli such as ergonovine can unmask or exacerbate limited coronary flow reserve during pacing in the absence of significant luminal changes of the epicardial coronary arteries.2, 3 Ergonovine-induced limitation in flow reserve resulted in precipitation of the patient's

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In vivo validation of a thermodilution method to determine regional left ventricular blood flow in patients with coronary disease.

Cited by 180 publications

References 14 publications

Regulation by insulin of myocardial glucose and fatty acid metabolism in the conscious dog.

Regulation by insulin of myocardial glucose and fatty acid metabolism in the conscious dog.

Effects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting

Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction.

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