Circulation, Vol 81, 1225-1235, Copyright © 1990 by American Heart Association
AS Bortone, OM Hess, A Gaglione, T Suter, H Nonogi, J Grimm and HP Krayenbuehl
Coronary vasomotion was studied at rest and during bicycle exercise with
biplane quantitative coronary arteriography in 28 patients with coronary
artery disease. Patients were divided into two groups; the first 18
patients served as controls (group 1), and the next 10 patients were
treated with propranolol 0.1 mg/kg, which was infused intravenously before
exercise (group 2). Luminal area of a normal and a stenotic vessel segment
was determined at rest, during supine bicycle exercise, and 5 minutes after
sublingual administration of 1.6 mg nitroglycerin after exercise. In group
1, the normal vessel showed vasodilation (+16%, p less than 0.001) during
exercise, whereas the stenotic vessel segment showed vasoconstriction
(-31%, p less than 0.001). After sublingual administration of
nitroglycerin, there was coronary vasodilation of both normal (+36%, p less
than 0.001 vs. rest) and stenotic (+20%, p less than 0.001) vessel
segments. Patients with angina pectoris during supine exercise (n = 10) had
significantly (p less than 0.05) more vasoconstriction (-36%) than patients
without angina (-23%). In group 2, intravenous administration of
propranolol at rest was associated with a decrease in luminal area of both
normal (- 24%, p less than 0.001) and stenotic (-43%, p less than 0.001)
vessel segments; however, during subsequent exercise, both normal (-2%, p =
NS vs. rest) and stenotic (-3%, p = NS vs. rest) vessel segments dilated
when compared with the measurements after propranolol. Administration of
nitroglycerin further increased luminal area of both vessel segments
(normal segment, +23%, p less than 0.001; stenotic segment, +46%, p less
than 0.001 vs. rest). It is concluded that dynamic exercise in patients
with coronary artery disease is associated with coronary vasodilation of
the normal and vasoconstriction of the stenotic coronary arteries. Patients
with exercise-induced angina had significantly more stenosis
vasoconstriction than patients without angina although minimal luminal area
at rest was similar. Intravenous administration of propranolol is
accompanied by a significant decrease in coronary luminal area of both
normal and stenotic vessel segments at rest, which is overridden by dynamic
exercise and sublingual nitroglycerin. The reduction in myocardial oxygen
consumption and the prevention of exercise-induced stenosis
vasoconstriction might explain the beneficial effect of beta-blocker
treatment in most patients with coronary artery disease.
ARTICLES
Effect of intravenous propranolol on coronary vasomotion at rest and during dynamic exercise in patients with coronary artery disease
Division of Cardiology, University Hospital, Zurich, Switzerland.
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