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Circulation, Vol 80, 458-465, Copyright © 1989 by American Heart Association
DA Cox, JA Vita, CB Treasure, RD Fish, RW Alexander, P Ganz and AP Selwyn
Studies in animals have suggested that increases in blood flow result in
dilation of large arteries by an endothelium-dependent mechanism.
Atherosclerosis can impair endothelium-dependent vasodilation to vasoactive
agents. The purpose of this study was to determine whether or not large
coronary arteries in humans exhibit dilation with increases in blood flow
and to test the hypothesis that this response is impaired in the presence
of atherosclerosis. Graded concentrations of adenosine were infused into
the distal left anterior descending (LAD) coronary artery to test the
dilator response of the proximal LAD to increases in blood flow. The
proximal LAD was thereby exposed to changes in blood flow, but not directly
to adenosine. Ten patients with angiographically smooth proximal LAD
segments (group 1) and seven patients with irregularities in the proximal
LAD consistent with mild atherosclerosis (group 2) were studied. Infusions
of adenosine throughout the range of 0.022 to 2.2 mg/min into the LAD
produced a dose-dependent increase in estimated coronary blood flow and a
mean increase of 305 +/- 27% at 2.2 mg/min adenosine. At 2.2 mg/min
adenosine, a striking difference (p less than 0.001) occurred between the
significant flow-mediated dilation of the proximal LAD observed in group 1
(+13.2 +/- 1.3% from 2.63 +/- 0.16 mm, p less than 0.001), and the lack of
dilation in group 2 (+1.8 +/- 1.5% from 3.20 +/- 0.17 mm, p = NS), despite
a greater increase in coronary blood flow in group 2 (+387 +/- 29%) than in
group 1 (+230 +/- 36%).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Atherosclerosis impairs flow-mediated dilation of coronary arteries in humans
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
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