Circulation, Vol 77, 43-52, Copyright © 1988 by American Heart Association
EG Nabel, P Ganz, JB Gordon, RW Alexander and AP Selwyn
Increased vascular constriction has been observed at the site of
atherosclerotic lesions, suggesting an association between atherosclerosis
and altered vascular tone. While atherosclerosis may increase sensitivity
to exogenous vasoconstrictors, little is known about the response of normal
and atherosclerotic coronary arteries to an exogenous stimulus that excites
the sympathetic nervous system. Therefore, we studied the response to cold
pressor test (CPT) using quantitative angiography and Doppler flow velocity
measurements in eight patients with angiographically normal coronary
arteries (group I), nine patients with mild coronary atherosclerosis (less
than 50% diameter narrowing) (group II), and 13 patients with advanced
coronary stenoses (greater than 50% diameter narrowing) (group III). In 31
segments of angiographically smooth arteries in group I, the CPT produced
vasodilation from a control mean diameter of 2.68 +/- 0.09 (mean +/- SE) to
2.99 +/- 0.09 mm at peak CPT (p less than 0.001), a 12 +/- 1% increase in
diameter. In group II, 27 irregular segments constricted to peak CPT from a
mean control diameter of 1.82 +/- 0.12 to 1.66 +/- 0.12 mm (p less than
.001), a 9 +/- 1% decrease, while 10 smooth segments dilated from a mean
control diameter of 1.98 +/- 0.11 mm to 2.34 +/- 0.15 mm (p less than .01),
a 19 +/- 2% increase in diameter. Likewise, in group III, the 17 stenotic
segments constricted from 1.16 +/- 0.09 to 0.89 +/- 0.09 mm (p less than
.001), a 24 +/- 6% decrease; the irregular segments also constricted from
2.44 +/- 0.11 to 2.22 +/- 0.12 mm (p = .002), a 10 +/- 2% decrease. In
contrast, two smooth segments dilated from 2.98 to 3.23 mm (mean), an 8%
increase in diameter. Coronary blood flow increased 65 +/- 4% (mean) during
CPT in group I, it increased 15 +/- 6% in group II, and it decreased 39 +/-
8% in group III. The vasodilator response in four normal patients was
partly inhibited by the administration of intracoronary propranolol (17 +/-
3% increase during control, 10 +/- 2% increase after propranolol, 41% less
dilation; p = .002). We conclude that the response of normal coronary
arteries to the CPT test is dilation, in part related to beta-
adrenoreceptor stimulation and possibly flow-mediated endothelial dilation
or alpha 2-adrenergic activity. The paradoxical vasoconstrictor response
induced by atherosclerosis may represent altered catecholamine sensitivity
and/or a defect in endothelial vasodilator function. The presence of
atherosclerosis impairs vasodilator responses and thus may contribute to
the pathogenesis of myocardial ischemia.
ARTICLES
Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressor test
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
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R. Marchioli, R. M. Marfisi, F. Carinci, and G. Tognoni Meta-analysis, Clinical Trials, and Transferability of Research Results Into Practice: The Case of Cholesterol-Lowering Interventions in the Secondary Prevention of Coronary Heart Disease Arch Intern Med, June 10, 1996; 156(11): 1158 - 1172. [Abstract] [PDF]
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J. Frielingsdorf, C. Seiler, P. Kaufmann, G. Vassalli, T. Suter, and O. M. Hess Normalization of Abnormal Coronary Vasomotion by Calcium Antagonists in Patients With Hypertension Circulation, April 1, 1996; 93(7): 1380 - 1387. [Abstract] [Full Text]
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G. N. Levine, B. Frei, S. N. Koulouris, M. D. Gerhard, J. F. Keaney Jr, and J. A. Vita Ascorbic Acid Reverses Endothelial Vasomotor Dysfunction in Patients With Coronary Artery Disease Circulation, March 15, 1996; 93(6): 1107 - 1113. [Abstract] [Full Text]
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N. H.J. Pijls, B. Van Gelder, P. Van der Voort, K. Peels, F. A.L.E. Bracke, H. J.R.M. Bonnier, and M. I.H. El Gamal Fractional Flow Reserve : A Useful Index to Evaluate the Influence of an Epicardial Coronary Stenosis on Myocardial Blood Flow Circulation, December 1, 1995; 92(11): 3183 - 3193. [Abstract] [Full Text]
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J. A. Blumenthal, W. Jiang, R. A. Waugh, D. J. Frid, J. J. Morris, R. E. Coleman, M. Hanson, M. Babyak, E. T. Thyrum, D. S. Krantz, et al. Mental Stress–Induced Ischemia in the Laboratory and Ambulatory Ischemia During Daily Life : Association and Hemodynamic Features Circulation, October 15, 1995; 92(8): 2102 - 2108. [Abstract] [Full Text]
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P. N. Petropoulakis, M. K. Kyriakidis, C. A. Tentolouris, C. V. Kourouclis, and P. K. Toutouzas Changes in Phasic Coronary Blood Flow Velocity Profile in Relation to Changes in Hemodynamic Parameters During Stress in Patients With Aortic Valve Stenosis Circulation, September 15, 1995; 92(6): 1437 - 1447. [Abstract] [Full Text]
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A. M. Zeiher, V. Schachinger, and J. Minners Long-term Cigarette Smoking Impairs Endothelium-Dependent Coronary Arterial Vasodilator Function Circulation, September 1, 1995; 92(5): 1094 - 1100. [Abstract] [Full Text]
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A. A. Quyyumi, N. Dakak, N. P. Andrews, D. M. Gilligan, J. A. Panza, and R. O. Cannon III Contribution of Nitric Oxide to Metabolic Coronary Vasodilation in the Human Heart Circulation, August 1, 1995; 92(3): 320 - 326. [Abstract] [Full Text]
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M. Gerhard and P. Ganz How Do We Explain the Clinical Benefits of Estrogen? : From Bedside to Bench Circulation, July 1, 1995; 92(1): 5 - 8. [Full Text]
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B. De Bruyne, J. Bartunek, S. U. Sys, and G. R. Heyndrickx Relation Between Myocardial Fractional Flow Reserve Calculated From Coronary Pressure Measurements and Exercise-Induced Myocardial Ischemia Circulation, July 1, 1995; 92(1): 39 - 46. [Abstract] [Full Text]
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A. M. Zeiher, T. Krause, V. Schachinger, J. Minners, and E. Moser Impaired Endothelium-Dependent Vasodilation of Coronary Resistance Vessels Is Associated With Exercise-Induced Myocardial Ischemia Circulation, May 1, 1995; 91(9): 2345 - 2352. [Abstract] [Full Text]
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G. N. Levine, J. F. Keaney, and J. A. Vita Cholesterol Reduction in Cardiovascular Disease -- Clinical Benefits and Possible Mechanisms N. Engl. J. Med., February 23, 1995; 332(8): 512 - 521. [Full Text] [PDF]
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