(Circulation. 1997;96:3390-3395.)
© 1997 American Heart Association, Inc.
Articles |
Coronary Endothelial Dysfunction in Humans Is Associated With Myocardial Perfusion Defects
From the Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minn.
Correspondence to Amir Lerman, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Background Coronary endothelial dysfunction may occur in patients with minimally obstructive coronary artery disease and angina, and potentially may cause myocardial ischemia.
Methods and Results Coronary
endothelium-dependent vasodilation was examined in
patients with angina and <50% coronary artery diameter (CAD)
stenosis by selectively infusing acetylcholine
(10-6 mol/L to 10-4 mol/L) into the left
anterior descending coronary artery (LAD). Percent change in
CAD (%
CAD) was measured by quantitative coronary
angiography, and percent change in coronary blood flow
(%CBF) was calculated using intracoronary flow Doppler.
Coronary endothelium-independent vasodilation
was examined using intracoronary adenosine and
nitroglycerin. 99mTc sestamibi was injected
intravenously just prior to the infusion of the highest
dose of acetylcholine. Patients were divided blindly into three groups:
Perfusion defects in non-LAD territory (group 1, n=6), no perfusion
defects (group 2, n=7), and perfusion defects in the LAD territory
(group 3, n=7). All patients had intact
endothelium-independent vasodilation. In group 1,
perfusion defects outside the LAD territory reflected an increase in
%CAD and %CBF by 24±5% and 241±46% in the LAD. In group 2,
%CAD decreased by 26±5%, but %CBF increased by 54±17%. In
group 3, perfusion defects were within the LAD territory, reflecting a
decrease in %CAD and %CBF by 35±5% and 51±14%,
respectively.
Conclusions This study demonstrates that coronary endothelial dysfunction in humans may be temporally associated with myocardial perfusion defects and supports a role for the coronary epicardial and microcirculation endothelium in regulating myocardial perfusion. Myocardial ischemia may occur in humans with impaired endothelium-dependent coronary flow reserve of the coronary epicardial and microcirculation.
Key Words: coronary disease • angina • vasodilation • microcirculation • perfusion
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A. Feldstein, J. D. Krier, M. H. Sarafov, A. Lerman, P. J. M. Best, S. H. Wilson, and L. O. Lerman In Vivo Renal Vascular and Tubular Function in Experimental Hypercholesterolemia Hypertension, October 1, 1999; 34(4): 859 - 864. [Abstract] [Full Text] [PDF]
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I. D. Cox, H. E. Botker, J. P. Bagger, H. S. Sonne, B. O Kristensen, and J. C. Kaski Elevated endothelin concentrations are associated with reduced coronary vasomotor responses in patients with chest pain and normal coronary arteriograms J. Am. Coll. Cardiol., August 1, 1999; 34(2): 455 - 460. [Abstract] [Full Text] [PDF]
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P. J. M. Best, C. J. McKenna, D. Hasdai, D. R. Holmes Jr, and A. Lerman Chronic Endothelin Receptor Antagonism Preserves Coronary Endothelial Function in Experimental Hypercholesterolemia Circulation, April 6, 1999; 99(13): 1747 - 1752. [Abstract] [Full Text] [PDF]
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D. Tousoulis, G. Davies, T. Crake, A. Lerman, D. Hasdai, and D. Holmes Acetylcholine and Endothelial Function • Response Circulation, October 13, 1998; 98 (15): 1587 - 1590. [Full Text] [PDF]
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A. Lerman, J. C. Burnett Jr, S. T. Higano, L. J. McKinley, and D. R. Holmes Jr Long-term L-Arginine Supplementation Improves Small-Vessel Coronary Endothelial Function in Humans Circulation, June 2, 1998; 97(21): 2123 - 2128. [Abstract] [Full Text] [PDF]
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