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14 Differential effects of exercise and nitrates on invasive haemodynamics in patients with coronary artery disease
  1. Tiffany Patterson1,
  2. Simone Rivolo2,
  3. Daniel Burkhoff3,
  4. Jan Schreuder4,
  5. Natalia Briceno1,
  6. Satpal Arri1,
  7. Kal Asrress1,
  8. Rupert Williams1,
  9. Brian Clapp5,
  10. Stam Kapetenakis5,
  11. Divaka Perera1,
  12. Mike Marber1,
  13. Jack Lee2,
  14. Simon R Redwood1
  1. 1Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, London
  2. 2Imaging Sciences Division, King’s College London, St. Thomas’ Hospital, London
  3. 3Cardiac Research Foundation, Columbia University, NY, USA
  4. 4CD Leycom, Zoetermeer, Netherlands
  5. 5Department of Cardiology, Guys and St Thomas NHS Foundation Trust, London


Background Exertional angina and the response to nitrates have been recognised for over two centuries. This ischaemic cascade and the mechanistic relief by nitrates has not been extensively studied. The aim was to identify these precise haemodynamic changes.

Methods In 31 patients with exertional angina and coronary artery disease, real-time simultaneous LV pressure-volume (PV) relations and invasive measures of coronary flow were performed in the cathlab. A novel software system was developed to analyse these simultaneous data.

Results Compared to control, exercise induced ischaemia (supine cath lab ergometer) led to a rightward, upward shift in end-systolic (39±14 versus 71±31 mL; p<0.001) and end-diastolic (90±28 vs 109±31 mL; p<0.05) PV relations, decreased cardiac output (7±2.3 versus 4.5±1.9; p<0.05) and impaired ventricular-arterial (VA) interaction (SVR 24±17 vs 44±18 mmHg.min/L; p<0.05). Nitrates induced an opposing effect with leftward, downward shift of end-systolic and diastolic PV relations, reduced cardiac work (1.2±0.4 versus 1.5±0.5 J; p<0.001) thus myocardial oxygen consumption, enhanced VA interaction and induced coronary stenosis dilatation (2.7±3.6 versus 4.4±3.3 mmHg/cm/sec; p<0.01).

Conclusions These data support the adverse haemodynamic consequences of ischaemia and the systemic and coronary vasodilatory effects of nitrates. The novel technology developed and used to assess real-time ventricular-arterial interaction has the potential to facilitate future works investigating haemodynamic change induced by disease states and therapeutic interventions.

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