| Evidence of a dominant backward-propagating "suction" wave responsible for diastolic coronary filling in humans, attenuated in left ventricular hypertrophy. | |
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MedLine Citation:
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PMID: 16585389 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Coronary blood flow peaks in diastole when aortic blood pressure has fallen. Current models fail to completely explain this phenomenon. We present a new approach-using wave intensity analysis-to explain this phenomenon in normal subjects and to evaluate the effects of left ventricular hypertrophy (LVH). METHOD AND RESULTS: We measured simultaneous pressure and Doppler velocity with intracoronary wires in the left main stem, left anterior descending, and circumflex arteries of 20 subjects after a normal coronary arteriogram. Wave intensity analysis was used to identify and quantify individual pressure and velocity waves within the coronary artery circulation. A consistent pattern of 6 predominating waves was identified. Ninety-four percent of wave energy, accelerating blood forward along the coronary artery, came from 2 waves: first a pushing wave caused by left ventricular ejection-the dominant forward-traveling pushing wave; and later a suction wave caused by relief of myocardial microcirculatory compression-the dominant backward-traveling suction wave. The dominant backward-traveling suction wave (18.2+/-13.7 x 10(3) W m(-2)s(-1), 30%) was larger than the dominant forward-traveling pushing wave (14.3+/-17.6 x 10(3) W m(-2) s(-1), 22.3%, P =0.001) and was associated with a substantially larger increment in coronary blood flow velocity (0.51 versus 0.14 m/s, P <0.001). In LVH, the dominant backward-traveling suction wave percentage was significantly decreased (33.1% versus 26.9%, P =0.01) and inversely correlated with left ventricular septal wall thickness (r =-0.52, P <0.02). CONCLUSIONS: Six waves predominantly drive human coronary blood flow. Coronary flow peaks in diastole because of the dominance of a "suction" wave generated by myocardial microcirculatory decompression. This is significantly reduced in LVH. |
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Authors:
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Justin E Davies; Zachary I Whinnett; Darrel P Francis; Charlotte H Manisty; Jazmin Aguado-Sierra; Keith Willson; Rodney A Foale; Iqbal S Malik; Alun D Hughes; Kim H Parker; Jamil Mayet |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2006-04-03 |
Journal Detail:
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Title: Circulation Volume: 113 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2006 Apr |
Date Detail:
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Created Date: 2006-04-11 Completed Date: 2006-05-18 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1768-78 Citation Subset: AIM; IM |
Affiliation:
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International Centre for Circulatory Health, St Mary's Hospital, Imperial College, Paddington, London W2 1LA, UK. coronarywia@heart123.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Blood Flow Velocity Coronary Angiography Coronary Circulation / physiology* Coronary Disease / physiopathology, radiography Diastole Echocardiography Female Heart Catheterization Hemodynamics Humans Hypertrophy, Left Ventricular / physiopathology* Male Microcirculation / physiology Middle Aged Myocardial Contraction* |
| Grant Support | |
ID/Acronym/Agency:
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077049/Z/05/Z//Wellcome Trust |
| Comments/Corrections | |
Comment In:
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Circulation. 2006 Apr 11;113(14):1721-2
[PMID:
16606800
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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