Heart 1997;78:480-487 ( November )
Right ventricular dysfunction during coronary artery occlusion: pressure-volume analysis using conductance catheters during coronary angioplasty
Royal
Brompton Hospital, London, UK
Correspondence to: Dr Bishop, Cardiac Department, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
Accepted for publication 22 July 1997
Objective
To study the effects of coronary artery
occlusion on the pressure-volume relations of the right ventricle.
DesignRight ventricular pressure-volume
cycles were studied using conductance catheters and micromanometers
in 19 subjects undergoing coronary angioplasty in a tertiary
referral cardiac centre.
ResultsCatheter occlusions of either the left
anterior descending coronary artery or the right coronary artery were
associated with a decline in stroke work (mean change (SD): left
13.3(15.8)%, p = 0.008; right 13.5(16.5)%, p = 0.04). Two
patterns of change were evident: an upward shift usually associated
with occlusion in the left coronary artery, and a rightward shift in
the right coronary artery. In the former there was an increase in
maximum ventricular volume (mean change: 3.0(2.7)%, p = 0.004) and
in minimum ventricular volume (mean change: 2.3(2.7)%, p = 0.01) and
a fall in peak pressure (mean change: 4.8(5.1)%, p = 0.04). In
the latter there was an increase in peak pressure (mean change 9.9(16.3)%, p = 0.04) and an increase in minimum ventricular volume (mean change 3.7(5.0)%, p = 0.02) leading to a fall in stroke volume
(mean change 13.3(15.8)%, p = 0.008).
ConclusionsOcclusion of the left anterior
descending coronary artery or the right coronary artery is associated
with a decline in right ventricular work. However, different patterns
of change in indices of preload and afterload lead to different effects
on overall right ventricular pump function.
© 1997 by Heart
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