Saline-induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis

Emanuele Gallinoro; Alessandro Candreva; Estefania Fernandez-Peregrina; Els Bailleul; Peter Meeus; Jeroen Sonck; Konstantinos Bermpeis; Dario Tino Bertolone; Giuseppe Esposito; Pasquale Paolisso; Ward Heggermont; Julien Adjedj; Emanuele Barbato; Carlos Collet; Bernard De Bruyne

doi:10.1016/j.atherosclerosis.2022.05.011

Saline-induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis

Emanuele Gallinoro, Alessandro Candreva, Estefania Fernandez-Peregrina, Els Bailleul, Peter Meeus, Jeroen Sonck, Konstantinos Bermpeis, Dario Tino Bertolone, Giuseppe Esposito, Pasquale Paolisso, Ward Heggermont, Julien Adjedj, Emanuele Barbato, Carlos Collet, Bernard De Bruyne^*

^*Corresponding author for this work

Carim - Cardiomyopathy

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND AND AIMS: Absolute coronary flow can be measured by intracoronary continuous thermodilution of saline through a dedicated infusion catheter (RayFlow®). A saline infusion rate at 15-20 mL/min induces an immediate, steady-state, maximal microvascular vasodilation. The mechanism of this hyperemic response remains unclear. We aimed to test whether local hemolysis is a potential mechanism of saline-induced coronary hyperemia.

METHODS: Twelve patients undergoing left and right catheterization were included. The left coronary artery and the coronary sinus were selectively cannulated. Absolute resting and hyperemic coronary flow were measured by continuous intracoronary thermodilution. Arterial and venous samples were collected from the coronary artery and the coronary sinus in five phases: baseline (BL); resting flow measurement (Rest, saline infusion at 10 mL/min); hyperemia (Hyperemia, saline infusion at 20 mL/min); post-hyperemia (Post-Hyperemia, 2 min after the cessation of saline infusion); and control phase (Control, during infusion of saline through the guide catheter at 30 mL/min).

RESULTS: Hemolysis was visually detected only in the centrifugated venous blood samples collected during the Hyperemia phase. As compared to Rest, during Hyperemia both LDH (131.50 ± 21.89 U/dL [Rest] and 258.33 ± 57.40 U/dL [Hyperemia], p < 0.001) and plasma free hemoglobin (PFHb, 4.92 ± 3.82 mg/dL [Rest] and 108.42 ± 46.58 mg/dL [Hyperemia], p < 0.001) significantly increased in the coronary sinus. The percentage of hemolysis was significantly higher during the Hyperemia phase (0.04 ± 0.02% [Rest] vs 0.89 ± 0.34% [Hyperemia], p < 0.001).

CONCLUSIONS: Saline-induced hyperemia through a dedicated intracoronary infusion catheter is associated with hemolysis. Vasodilatory compounds released locally, like ATP, are likely ultimately responsible for localized microvascular vasodilation.

Original language	English
Pages (from-to)	46-52
Number of pages	7
Journal	Atherosclerosis
Volume	352
Early online date	17 May 2022
DOIs	https://doi.org/10.1016/j.atherosclerosis.2022.05.011
Publication status	Published - Jul 2022

Keywords

ADENOSINE
ARTERIES
Absolute coronary flow
BLOOD-FLOW MEASUREMENT
CELLS
Fractional flow reserve
Microvascular dysfunction
Microvascular resistance

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10.1016/j.atherosclerosis.2022.05.011

Cite this

Gallinoro, E., Candreva, A., Fernandez-Peregrina, E., Bailleul, E., Meeus, P., Sonck, J., Bermpeis, K., Bertolone, D. T., Esposito, G., Paolisso, P., Heggermont, W., Adjedj, J., Barbato, E., Collet, C., & De Bruyne, B. (2022). Saline-induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis. Atherosclerosis, 352, 46-52. https://doi.org/10.1016/j.atherosclerosis.2022.05.011

@article{e9d9964e1dfa45e0a1ab826a5f3ce699,

title = "Saline-induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis",

abstract = "BACKGROUND AND AIMS: Absolute coronary flow can be measured by intracoronary continuous thermodilution of saline through a dedicated infusion catheter (RayFlow{\textregistered}). A saline infusion rate at 15-20 mL/min induces an immediate, steady-state, maximal microvascular vasodilation. The mechanism of this hyperemic response remains unclear. We aimed to test whether local hemolysis is a potential mechanism of saline-induced coronary hyperemia.METHODS: Twelve patients undergoing left and right catheterization were included. The left coronary artery and the coronary sinus were selectively cannulated. Absolute resting and hyperemic coronary flow were measured by continuous intracoronary thermodilution. Arterial and venous samples were collected from the coronary artery and the coronary sinus in five phases: baseline (BL); resting flow measurement (Rest, saline infusion at 10 mL/min); hyperemia (Hyperemia, saline infusion at 20 mL/min); post-hyperemia (Post-Hyperemia, 2 min after the cessation of saline infusion); and control phase (Control, during infusion of saline through the guide catheter at 30 mL/min).RESULTS: Hemolysis was visually detected only in the centrifugated venous blood samples collected during the Hyperemia phase. As compared to Rest, during Hyperemia both LDH (131.50 ± 21.89 U/dL [Rest] and 258.33 ± 57.40 U/dL [Hyperemia], p < 0.001) and plasma free hemoglobin (PFHb, 4.92 ± 3.82 mg/dL [Rest] and 108.42 ± 46.58 mg/dL [Hyperemia], p < 0.001) significantly increased in the coronary sinus. The percentage of hemolysis was significantly higher during the Hyperemia phase (0.04 ± 0.02% [Rest] vs 0.89 ± 0.34% [Hyperemia], p < 0.001).CONCLUSIONS: Saline-induced hyperemia through a dedicated intracoronary infusion catheter is associated with hemolysis. Vasodilatory compounds released locally, like ATP, are likely ultimately responsible for localized microvascular vasodilation.",

keywords = "ADENOSINE, ARTERIES, Absolute coronary flow, BLOOD-FLOW MEASUREMENT, CELLS, Fractional flow reserve, Microvascular dysfunction, Microvascular resistance",

author = "Emanuele Gallinoro and Alessandro Candreva and Estefania Fernandez-Peregrina and Els Bailleul and Peter Meeus and Jeroen Sonck and Konstantinos Bermpeis and Bertolone, {Dario Tino} and Giuseppe Esposito and Pasquale Paolisso and Ward Heggermont and Julien Adjedj and Emanuele Barbato and Carlos Collet and {De Bruyne}, Bernard",

note = "Copyright {\textcopyright} 2022. Published by Elsevier B.V.",

year = "2022",

month = jul,

doi = "10.1016/j.atherosclerosis.2022.05.011",

language = "English",

volume = "352",

pages = "46--52",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

}

Gallinoro, E, Candreva, A, Fernandez-Peregrina, E, Bailleul, E, Meeus, P, Sonck, J, Bermpeis, K, Bertolone, DT, Esposito, G, Paolisso, P, Heggermont, W, Adjedj, J, Barbato, E, Collet, C & De Bruyne, B 2022, 'Saline-induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis', Atherosclerosis, vol. 352, pp. 46-52. https://doi.org/10.1016/j.atherosclerosis.2022.05.011

TY - JOUR

T1 - Saline-induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis

AU - Gallinoro, Emanuele

AU - Candreva, Alessandro

AU - Fernandez-Peregrina, Estefania

AU - Bailleul, Els

AU - Meeus, Peter

AU - Sonck, Jeroen

AU - Bermpeis, Konstantinos

AU - Bertolone, Dario Tino

AU - Esposito, Giuseppe

AU - Paolisso, Pasquale

AU - Heggermont, Ward

AU - Adjedj, Julien

AU - Barbato, Emanuele

AU - Collet, Carlos

AU - De Bruyne, Bernard

PY - 2022/7

Y1 - 2022/7

N2 - BACKGROUND AND AIMS: Absolute coronary flow can be measured by intracoronary continuous thermodilution of saline through a dedicated infusion catheter (RayFlow®). A saline infusion rate at 15-20 mL/min induces an immediate, steady-state, maximal microvascular vasodilation. The mechanism of this hyperemic response remains unclear. We aimed to test whether local hemolysis is a potential mechanism of saline-induced coronary hyperemia.METHODS: Twelve patients undergoing left and right catheterization were included. The left coronary artery and the coronary sinus were selectively cannulated. Absolute resting and hyperemic coronary flow were measured by continuous intracoronary thermodilution. Arterial and venous samples were collected from the coronary artery and the coronary sinus in five phases: baseline (BL); resting flow measurement (Rest, saline infusion at 10 mL/min); hyperemia (Hyperemia, saline infusion at 20 mL/min); post-hyperemia (Post-Hyperemia, 2 min after the cessation of saline infusion); and control phase (Control, during infusion of saline through the guide catheter at 30 mL/min).RESULTS: Hemolysis was visually detected only in the centrifugated venous blood samples collected during the Hyperemia phase. As compared to Rest, during Hyperemia both LDH (131.50 ± 21.89 U/dL [Rest] and 258.33 ± 57.40 U/dL [Hyperemia], p < 0.001) and plasma free hemoglobin (PFHb, 4.92 ± 3.82 mg/dL [Rest] and 108.42 ± 46.58 mg/dL [Hyperemia], p < 0.001) significantly increased in the coronary sinus. The percentage of hemolysis was significantly higher during the Hyperemia phase (0.04 ± 0.02% [Rest] vs 0.89 ± 0.34% [Hyperemia], p < 0.001).CONCLUSIONS: Saline-induced hyperemia through a dedicated intracoronary infusion catheter is associated with hemolysis. Vasodilatory compounds released locally, like ATP, are likely ultimately responsible for localized microvascular vasodilation.

AB - BACKGROUND AND AIMS: Absolute coronary flow can be measured by intracoronary continuous thermodilution of saline through a dedicated infusion catheter (RayFlow®). A saline infusion rate at 15-20 mL/min induces an immediate, steady-state, maximal microvascular vasodilation. The mechanism of this hyperemic response remains unclear. We aimed to test whether local hemolysis is a potential mechanism of saline-induced coronary hyperemia.METHODS: Twelve patients undergoing left and right catheterization were included. The left coronary artery and the coronary sinus were selectively cannulated. Absolute resting and hyperemic coronary flow were measured by continuous intracoronary thermodilution. Arterial and venous samples were collected from the coronary artery and the coronary sinus in five phases: baseline (BL); resting flow measurement (Rest, saline infusion at 10 mL/min); hyperemia (Hyperemia, saline infusion at 20 mL/min); post-hyperemia (Post-Hyperemia, 2 min after the cessation of saline infusion); and control phase (Control, during infusion of saline through the guide catheter at 30 mL/min).RESULTS: Hemolysis was visually detected only in the centrifugated venous blood samples collected during the Hyperemia phase. As compared to Rest, during Hyperemia both LDH (131.50 ± 21.89 U/dL [Rest] and 258.33 ± 57.40 U/dL [Hyperemia], p < 0.001) and plasma free hemoglobin (PFHb, 4.92 ± 3.82 mg/dL [Rest] and 108.42 ± 46.58 mg/dL [Hyperemia], p < 0.001) significantly increased in the coronary sinus. The percentage of hemolysis was significantly higher during the Hyperemia phase (0.04 ± 0.02% [Rest] vs 0.89 ± 0.34% [Hyperemia], p < 0.001).CONCLUSIONS: Saline-induced hyperemia through a dedicated intracoronary infusion catheter is associated with hemolysis. Vasodilatory compounds released locally, like ATP, are likely ultimately responsible for localized microvascular vasodilation.

KW - ADENOSINE

KW - ARTERIES

KW - Absolute coronary flow

KW - BLOOD-FLOW MEASUREMENT

KW - CELLS

KW - Fractional flow reserve

KW - Microvascular dysfunction

KW - Microvascular resistance

U2 - 10.1016/j.atherosclerosis.2022.05.011

DO - 10.1016/j.atherosclerosis.2022.05.011

M3 - Article

C2 - 35667163

SN - 0021-9150

VL - 352

SP - 46

EP - 52

JO - Atherosclerosis

JF - Atherosclerosis

ER -