Mechanisms of collateral development and hemodynamics of gradual coronary occlusion

Anatomic basis for the injury current producing ST-segment shifts on the body surface ECG

ST-segment depression is the characteristic electrocardiographic response to myocardial ischemia. A hypothesis is presented defining the structural and functional requirements for ischemic blood flow and ST-T wave potential gradients for ST-segment depression to occur. Both flow and potential gradients may be either transmural or transventricular. ST-segment depression results only when both are concordant (e.g., both transmural); however, ischemic ST-segment depression does not follow when flow and potential gradients are discordant (e.g., one transmural and one transventricular).

Effects of experimental myocardial infarction on the ST segment response to tachycardia

Prior studies have shown that tachycardia results in ST segment depression in dogs with chronic, gradual coronary occlusion. This response was compared with that produced by acute, total occlusion of the left anterior descending artery. Ten dogs served as controls; in another 10 dogs, an ameroid constrictor was implanted about the left anterior descending artery. This artery was acutely ligated in a third set of 10 animals, and in a final set of 10, the distal left anterior descending coronary vasculature was embolized by latex injection. Tachycardia was produced by atrial pacing from rates of 90 to 250 beats/min using implanted atrial electrodes. Electrocardiographic signals registered from 84 torso electrodes were used to construct body surface isopotential maps during the ST segment. In normal dogs, pacing increased repolarization potentials without shifts in spatial features. New and abnormal anterior negativity, correlating with significant ST depression, appeared at rates of 170 beats/min or faster in dogs with ameroid constriction. However, in both groups with acute occlusion that produced transmural myocardial infarction, tachycardia resulted in increases in anterior ST elevation and reciprocal ST depression. Specific findings demonstrated the lead dependency of the response to tachycardia and the greater than normal increase in potential magnitudes after infarction than in control cases. The similarity of the response with acute occlusion and with embolization suggested that the response to tachycardia after infarction was not dependent on coronary collateral function but may represent a direct electrophysiologic effect of rate. Thus, these acute occlusion models simulate exercise-induced ST segment elevation as it may be seen clinically.

Ability of standard ECG parameters to detect the body surface isopotential abnormalities of pacing induced myocardial ischemia in the dog

The ability of parameters derived from standard, scalar ECG leads to predict abnormal body surface isopotential distributions was tested in 25 dogs. Atrial pacing to rates of 170 beats per minute or greater, two weeks after implantation of an ameroid constrictor on the left circumflex coronary artery, resulted in abnormal isopotential patterns due to subendocardial ischemia. A total of 96 scalar ECG variables (potential and slope measurements at 20, 40, 60 and 80 msec into the ST-segment in each of 12 leads) were computed. Ability of each variable and potential-slope pairs to distinguish normal from ischemic map forms was tested using discriminant function analysis and simple classification procedures. Results demonstrated that accuracy of prediction was lead-dependent, and time-dependent, with different sensitivities, specificities and boundary values in different leads and at different instants during the ST-segment. These new concepts may have direct relevance to the selection of clinical exercise ECG diagnostic criteria.

Electrocardiographic effects of myocardial ischemia induced by atrial pacing in dogs with coronary stenosis. II. Comparison of S-T segment and QRS changes in dogs with left circumflex arterial narrowing

The effects of tachycardia on the QRS complex in the absence and in the presence of coronary arterial constriction are of possible clinical significance. To study the spatial and temporal distributions of these effects, a canine model simulating progressive coronary occlusion was studied. Tachycardia was induced by atrial pacing, coronary narrowing was produced by implantation of an ameroid constrictor about the left circumflex coronary artery and electrocardiographic effects were studied by isopotential mapping techniques at rates of up to 250 beats per minute, one to three weeks after constrictor implant. In five dogs. pacing without coronary constriction demonstrated the spatial and temporal dependence of QRS changes; tachycardia-induced changes varied from one torso site to another at any instant, and from one moment to another at any one torso location. Patterns in ten dogs with constrictors were dependent upon time after ameroid placement. Resting QRS and S-T segment distributions remained unchanged. One week after surgery, QRS and S-T segment patterns during pacing were as in controls. Two weeks after surgery, QRS patterns were as in controls but flat S-T segment depression resulted at high rates. After three weeks, QRS patterns during pacing were abnormal and S-T segment depression was observed. At each of the later times, the QRS response was similar at rates which did and which did not cause S-T depression. Thus, the effects of tachycardia on excitation and recovery forces in the presence of restricted coronary flow are independent of one another. This suggests that the two responses to ischemia may be due to different basic mechanisms and, hence, that their detection may reflect different myocardial abnormalities.

Differential electrocardiographic effects of myocardial ischemia induced by atrial pacing in dogs with various locations of coronary stenosis

The spatial distribution of abnormal repolarization potentials caused by regional myocardial ischemia was determined in 45 dogs. Ameroid constrictors were placed around the left circumflex artery in 10, the left anterior descending artery in 10, and the right coronary artery in 10. Ten dogs without constrictors served as controls. Electrocardiographic events were determined from body surface isopotential distributions, which were computed from potentials sensed by 84 torso electrodes. In control dogs, pacing to heart rates of 230 to 250 beats/min increased the intensity of positive and negative surface extrema during the ST segment without altering their spatial features. Two weeks after placement of the ameroid constrictors, tachycardia induced abnormal negative potentials during the ST segment. Localization of these ischemic forces varied with the placement of the constrictor in a manner consistent with the affected perfusion territories. However, much of the torso surface was involved by all lesions, and only small zones of ST segment depression unique to specific lesions could be identified. In five additional dogs a constrictor was placed on the right coronary artery 3 months after implantation of a device on the circumflex vessel. ST segment patterns during pacing in dogs with two lesions were consistent with the sum of the two individual lesions. Thus, the regional nature of myocardial ischemia is detectable in the body surface isopotential distributions, but the degree of spatial overlap may limit the value of such techniques in extending the usefulness of clinical exercise-stress electrocardiography.

Collateral arterial capacity following acute iliac occlusion in the rat

The development of collateral circulation after ligation of the left iliac artery was studied in 46 rats by means of microsphere distribution in muscles of both lower limbs. The radioactive microspheres were injected into the aortic root in the hyperemic phase after 5 min of cuff-induced ischemia of the lower extremities. The hyperemic response to cuff-induced ischemia as well as microsphere distribution between both lower limbs in control animals were studied separately in 23 rats. The largest hyperemic response occurred 15-30 s after cuff-induced ischemia. After iliac artery ligation, flow in the thigh increased from 43% of control value 20 min after ligation to 70% after 26 days of recovery. Flow in calf muscles increased correspondingly from 4% to 33%. This study quantifies the capacity of collateral formation following acute iliac artery occlusion.

Electrocardiographic effects of myocardial ischemia induced by atrial pacing in dogs with coronary stenosis. I. Repolarization changes with progressive left circumflex coronary. artery narrowing

The electrocardiographic effects of tachycardia in normal dogs and in dogs with progressive coronary stenosis were studied. In five animals, left atrial electrodes were surgically implanted and body surface isopotential patterns were recorded from 84 torso electrodes; pacing at rates of up to 250 beats/min increased recorded voltages registered during the ST segment but did not alter the spatial distribution of these potentials. In 10 dogs, an ameroid constrictor was also implanted about the left circumflex coronary artery. One week after surgery, pacing to rates of 250 beats/min had no effect on ST segment isopotential patterns. However, 2 and 3 weeks postoperatively, when significant coronary constriction was anticipated, pacing-induced ST segment depression was recorded along the inferior anterior and posterior chest surfaces. Abnormal negative voltages were more intense at 3 than at 2 weeks, but the distribution of these abnormalities was unchanged. This pattern was consistent with the location of ischemic myocardium. Calculation of early (10 to 40 ms) ST segment slopes demonstrated that downsloping forms were recorded over most of the area with abnormal ST segment voltages, but that horizontal or upsloping depression occurred at the margins of the abnormal zones. The findings suggest that this canine model may be a useful analog to clinical exercise stress testing to aid in evaluating the significance of clinical electrocardiographic patterns.

Middle cerebral artery occlusion in the young rat

This investigation describes a surgical approach for ligation of the middle cerebral artery (MCA) in the young rat and evaluates consequences of the occlusion with a neurologic exam for motor deficits, Evans blue test for blood-brain barrier leaks, and light microscopy for histologic changes after 3 days. Evans blue extravasation and the lesion were limited to cortex at the burr hole site in occluded and sham operated rats. MCA occlusion beyond the point of origin of the striate branches in the young rat results in neither neurological deficits, dye markings, nor histologic changes in the distal vascular field to indicate an infarct. Apparently, the young rodent collateral supply maintains the tissue in a viable state.

Changes in coronary and collateral flows and adequacy of perfusion in the dog following one and three months of circumflex occlusion

We investigated changes in circumflex, left anterior descending (LAD), and right coronary artery flows as well as changes in collateral flows to these vessels after long-term circumflex occlusion. Coronary and collateral flows of each vessel were determined simultaneously in an isolated heart preparation in which the vasculature was maximally dilated with dipyridamole. The resistances as related to total heart weight of the circumflex, LAD, and right coronary arteries of 16 control dogs were found to be 0.59 +/- 0.06, 0.93 +/- 0.09, and 2.37 +/- 0.17 (mean +/- SEM) mm Hg/[(ml/min)/100 g], respectively. Total minimal coronary resistance was 0.21 +/- 0.01. In 10 dogs subjected to occlusion for 1 month no significant change in circumflex coronary resistance was observed, but the resistance of the unimpaired vessels decreased significantly. The resistances of the LAD and right coronary arteries were 0.66 +/-0.04 and 1.72 +/- 0.13, respectively. Both values were considerably less (P less than 0.01) than control. In nine dogs subjected to occlusion for 3 months the resistance of the unimpaired LAD and right arteries, as well as the circumflex coronary resitance, were not significantly different from control. We also found that retrograde flows for all vessels increased 7-fold after 1 month and 10.5-fold (relative to control) after 3 months of occlusion. From these data we conclude that vascular adaptations, which occurred in response to an ischemic stimulus, are responsible for the long-term regulation of the metabolic needs of the myocardium.

Cellular basis for increased sensitivity of vascular smooth muscle in spontaneously hypertensive rats

There is evidence that hypersensitivity of vascular muscle to neurotransmitters contributes to the development of hypertension. Comparison of the caudal arteries of spontaneously hypertensive rats (SHR) and their genetically related Kyoto-Wistar normotensive control rats (KNR) showed that although there is no difference in membrane potential under unstimulated conditions, greater depolarization of the SHR vascular muscle cells by norepinephrine occurs at concentrations which cause greater contraction. The mechanism for the increased depolarization and resulting increase in contraction appears to be a lower intracellular potassium ion activity in SHR vascular muscle cells, which results in a lower contribution of potassium gradient to membrane potential. Experiments to determine the sensitivity of isolated, dispersed chick omphalomesenteric vascular muscle cells to neurotransmitters showed remarkably low thresholds to the neutransmitters norepinephrine, serotonin, and acetylcholine, but not potassium chloride. The high sensitivity of isolated cells to neurotransmitters suggests that factors in the intact vessel may cause thresholds to be high, possibly implying that alterations in a neurotrophic mechanism might be responsible for changes in vascular muscle sensitivity in situ.

Effects of chronic anemia on the coronary and coronary collateral vasculature in dogs

We compared coronary resistances and collateral (retrograde) flows for a group of normal dogs (hematocrit 40) to values for a group of dogs with severe chronic anemia (hematocrit 17). We used an isolated heart preparation in which the vessels were maximally dilated by dipyridamole. All data were compared for a hematocrit of 40. The results showed a significant decrease in coronary resistances with anemia; average resistances (+/-SE) of the anterior descending, circumflex, and right coronary arteries of the control dogs were 1.04 +/- 0.09,0.74 +/- 0.01, and 2.63 +/- 0.17 mm Hg/[(ml/min)/100 g], respectively, and 0.6 +/- 0.04,0.41 +/- 0.05,and 1.17 +/- 0.15 for the anemic dogs. Average coronary collateral flows increased in anemia but statistical significance could not be shown. We conclude that increased vascularity is a long-term regulatory mechanism in response to a hypoxic stimulus.