The evolution of myocardial ischaemia during percutaneous transluminal coronary angioplasty

Griffin, Brian P.; Crick, J. C. P.; Sowton, Edgar

doi:10.1093/oxfordjournals.eurheartj.a062284

Cited by 29 publications

(8 citation statements)

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“…The 2 min reperfusion period utilized between balloon inflations in the present study was sufficiently long that the induced systolic dysenergy disappeared and VCG changes returned to baseline. This is consistent with other studies [4,5,23,25].…”

Section: Discussionsupporting

confidence: 94%

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Deterioration in peak systolic velocity is closely related to ischaemia during angioplasty: a vectorcardiographic and tissue Doppler imaging study

Jensen¹,

Brodin²,

Lind³

et al. 2000

Clinical Science

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We tested the hypothesis that the extent of signs of ischaemia detected by vectorcardiography (VCG) during elective coronary angioplasty (percutaneous transluminal coronary angioplasty; PTCA) is related to systolic and diastolic myocardial velocities, as determined by tissue Doppler echocardiography. A total of 15 patients undergoing PTCA (12 men/three women; age 61+/-9 years), without prior myocardial infarction and with an ejection fraction of >50%, were included. The balloon inflation was repeated three times, with minimum intervals of 2 min between inflations. Tissue Doppler echocardiography was performed, in an apical two- or four-chamber view, before and at the end of each inflation. Peak systolic velocity, time-to-peak systolic velocity (TTP), peak early (E(m)) and late (A(m)) diastolic velocities, the E(m)/A(m) ratio and isovolumic relaxation time were measured in the basal segments of the left ventricle. VCG recordings were carried out during the whole procedure. ST vector magnitude (ST-VM) and ST change vector magnitude (STC-VM) were monitored. The total duration and area of each VCG change during inflation were calculated for each patient. Isovolumic relaxation time, peak E(m) and A(m) values and the E(m)/A(m) ratio did not change significantly during inflation. Peak systolic velocity decreased (6.7+/-2.0 to 5.3+/-1.9 cm/s; P<0.001) and TTP increased (157+/-60 to 192+/-60 ms; P<0.01) during inflation. Both STC-VM time (r=-0.68, P<0.01) and STC-VM area (r=-0.68, P<0.01) were related to peak systolic velocity during inflation. STC-VM time was also related (r=0.55, P<0.05) to the difference in peak systolic velocity during compared with before inflation. ST-VM was less closely related to peak systolic velocity. Thus the duration and degree of ischaemia, as measured by VCG, are related to peak systolic velocity in the basal segments of the left ventricle.

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Section: Discussionsupporting

confidence: 94%

“…Balloon inflation during percutaneous transluminal coronary angioplasty (PTCA) causes a total interruption of [3][4][5]. ECG and echocardiography are of established value for the identification of electrical and mechanical abnormalities in acute myocardial ischaemia [6,7].…”

Section: Introductionmentioning

confidence: 99%

Deterioration in peak systolic velocity is closely related to ischaemia during angioplasty: a vectorcardiographic and tissue Doppler imaging study

Jensen¹,

Brodin²,

Lind³

et al. 2000

Clinical Science

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“…This leads, after sorting of variables, to: which can be rewritten as with Zfif^ defined as (14) • (Gf,f,G^^P^^ -P^f,). (15) Appendix B: Boundary Element Integration…”

Section: Appendix A: the Forward Solutionmentioning

confidence: 99%

Application of an Electrocardiographic Inverse Solution to Localize Ischemia During Coronary Angioplasty

MacLeod

Gardner

et al. 1995

Cardiovasc electrophysiol

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Localization of Ischemia. This study demonstrates the utility of an electrocardiographic inverse solution, coupled with body surface potential mapping (BSPM), in localizing acute ischemia in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). PTCA balloon inflations produce complete occlusion and acute transient ischemia, which can be detected electrocardiographically with BSPM. Comparisons between maps recorded both during and before the inflation of the PTCA balloon allow patient- and artery-specific characterizations of the resulting ischemia. Knowledge of the patient's coronary anatomy and the location of the occlusion site by coronary angiography permit an estimation based on cardiac hemodynamics of the region of myocardium most likely to suffer from PTCA-induced ischemia. Electrocardiographic inverse solutions provide a means of predicting cardiac potentials from body surface maps. In this study, we describe an inverse solution we have developed to localize the transient ischemia produced by PTCA. To validate the procedure, we compared the locations of predicted ischemia in seven patients with a qualitative estimate of the perfusion region based on fluoroscopic examination of each patient's coronary anatomy and PTCA balloon location. In each case, the region of ischemia predicted by the model included the perfusion zone determined fluoroscopically. These results suggest that electrical changes induced by acute ischemia can be localized with an electrocardiographic inverse solution.

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“…The 12-lead electrocardiogram (ECG) may show ST segment change within seconds of an ischemic insult 3 and, thus, remains a central tool for early evaluation of chest pain patients. However, ST elevation, the only 12-lead ECG marker with adequate specificity, has less than 60% sensitivity for diagnosis of acute MI.…”

Section: Rationale For Body Surface Mapping In Acute Coronary Syndromesmentioning

confidence: 99%

Body Surface Mapping

Menown¹

2003

Critical Pathways in Cardiology: A Journal of Evidence-Based Me

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Recent advances in biomarkers have improved the evaluation of patients with acute chest pain, but current critical care pathways may still lead to important delays in early diagnosis and, hence, treatment of acute myocardial infarction (AMI). Electrocardiographic changes may occur within seconds of an ischemic insult, but the conventional 12-lead electrocardiogram (ECG) typically has only 50% to 60% sensitivity for diagnosis of AMI. Recording of multiple ECGs over a larger thoracic surface area, including the right ventricular, high left lateral, and posterior regions, by body surface mapping (BSM) has been made feasible in the setting of acute coronary syndromes by novel developments in electrode technology and simultaneous multichannel ECG data acquisition. Clinical studies of an Food and Drug Adminstration-approved BSM system (PRIME-ECG) have demonstrated improved early diagnosis of AMI in patients without 12-lead ST elevation and improved detection of right ventricular or posterior involvement in ST elevation MI. The improved diagnostic sensitivity compared with the conventional 12-lead ECG coupled with the potential reduction of delay to diagnosis compared with biomarkers suggest that BSM may have an important role as part of a chest pain critical care pathway for evaluation of patients with ischemic type chest pain.

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The evolution of myocardial ischaemia during percutaneous transluminal coronary angioplasty

Cited by 29 publications

References 0 publications

Deterioration in peak systolic velocity is closely related to ischaemia during angioplasty: a vectorcardiographic and tissue Doppler imaging study

Deterioration in peak systolic velocity is closely related to ischaemia during angioplasty: a vectorcardiographic and tissue Doppler imaging study

Application of an Electrocardiographic Inverse Solution to Localize Ischemia During Coronary Angioplasty

Body Surface Mapping

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