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PubMed1984

Effect of intravenous dipyridamole on regional coronary blood flow with 1-vessel coronary artery disease: evidence against coronary steal.

The effects of i.v. dipyridamole were studied in 9 patients with isolated total left anterior descending coronary artery (LAD) obstruction, in 6 patients with isolated 90 to 99% diameter reduction of the LAD and in 10 patients with normal coronary arteries and normal left ventricular function. Coronary sinus and great cardiac vein flows were determined by continuous thermodilution. Flows were measured at rest and 1, 3, 5 and 10 minutes after i.v. dipyridamole. Great cardiac vein flow represents the venous outflow from the LAD territory. In the presence of coronary steal from the LAD territory, great cardiac vein flow is expected to decrease while coronary sinus flow increases. Intravenous dipyridamole induced a similar flow increase in the coronary sinus and the great cardiac vein in all 3 groups (p less than 0.001 between rest and dipyridamole, difference not significant among groups), suggesting that no coronary steal was induced. The maximal increase in great cardiac vein flow was 118 +/- 74% in the control group, 86 +/- 74% in the group with 90 to 99% LAD obstruction and 102 +/- 29% in the group with total LAD obstruction (difference not significant). These data show that i.v. dipyridamole produces a similar increase in coronary flow in ischemic and nonischemic areas and suggests that an increase in collateral flow is the underlying mechanism for increased flow to the ischemic area.

Adult↗
PubMed1994

[Digoxin-induced constriction of epicardial coronary vessels in patients with coronary heart disease: reversibility by nitrates].

Heart diseases requiring glycoside therapy are often associated with coronary artery disease. This study evaluated quantitatively the effect of an intravenous bolus injection of digoxin (0.8 mg) on diameters of epicardial coronary arteries in 11 patients with coronary artery disease. Coronary angiograms were taken up to 30 min following intravenous administration of glycosides. The maximum decrease in mean diameters of angiographically normal coronary segments was 10.0 +/- 3.5% (p < or = 0.001) compared to control. Maximum reduction in minimal diameters of stenotic segments was 22.1 +/- 13.1% (p < or = 0.001). This vasoconstriction could be reversed with nitroglycerin. Thus, intravenous administration of digoxin induces vasoconstriction of normal and stenotic coronary arteries, which could cause ischemic complications in the presence of high-grade stenoses. Since digoxin-induced vasoconstriction could be reversed with nitroglycerin, concomitant vasodilator therapy is recommended.

Adult↗
PubMed1992

Contribution of nitric oxide to dilation of resistance coronary vessels in conscious dogs.

Endothelium-dependent relaxation of conductance coronary vessels involves nitric oxide formation from L-arginine. The present study examines whether a similar mechanism intervenes in the vasomotor control of resistance coronary vessels. In conscious dogs, the excess of coronary blood flow (CBF) created by intracoronary acetylcholine (3.0 ng/kg) averaged 7.2 +/- 1.1 ml. Intracoronary adenosine (100 ng/kg) increased CBF by 12.4 +/- 1.4 ml. Intracoronary nitroglycerin (175 ng/kg) increased CBF by 7.4 +/- 1.2 ml. CBF repayment-to-debt ratio after a 15-s coronary arterial occlusion averaged 2.8 +/- 0.2. After an intracoronary N omega-nitro-L-arginine dose (10 micrograms.kg-1.min-1 x 12 min) was given to inhibit nitric oxide formation, baseline CBF was not altered. CBF increases with acetylcholine averaged 2.4 +/- 0.5 and 6.4 +/- 0.7 ml with adenosine, both less (P less than 0.01) than responses before the arginine analogue. CBF increases with nitroglycerin averaged 7.2 +/- 1.1 ml, similar to control responses. CBF repayment-to-debt ratio during reactive hyperemic responses fell (P less than 0.01) to 1.7 +/- 0.1. L-Arginine (1.0 mg.kg-1.min-1 x 12 min) partially reversed the inhibitory effect of the arginine analogue on CBF responses to acetylcholine. Thus nitric oxide formed in resistance coronary vessels is a major mediator of coronary vasodilation to acetylcholine, adenosine and transient ischemia.

Acetylcholine↗
PubMed1987

Improved survival with coronary bypass surgery in patients with three-vessel coronary disease and abnormal left ventricular function. Matched case-control study in patients with potentially operable disease.

Recent studies have suggested that patients with three-vessel coronary disease and abnormal left ventricular function have better survival rates with bypass surgery than with medical therapy alone. Case-control studies may give accurate survival estimates, but to be valid, selection biases must be taken into account. A matched case-control method was used to compare survival patterns in patients treated medically or surgically during the 1980s. Fifty medical patients with potentially operable coronary disease and 46 surgical patients were matched for significant three-vessel disease and abnormal ventricular function. These two groups had no significant differences with regard to 24 variables, including age (64 +/- 8 versus 63 +/- 10 years), chest pain class, congestive heart failure signs, ejection fraction (36 +/- 8 versus 37 +/- 9 percent), segmental wall score, or a coronary score evaluating lesion site and severity. There were slight differences between the two groups with regard to congestive heart failure symptoms (p = 0.04). Patients undergoing bypass surgery had improved four-year survival rates compared with the medical group (89 versus 55 percent; p = 0.01). Thus, this study used an effective case-control method to suggest that, in the 1980s, coronary surgery improves prognosis substantially in surgically approachable patients with severe coronary disease and ventricular dysfunction.

Aged↗
PubMed1992

Improvement in long-term prognosis by coronary bypass surgery in patients with 3-vessel coronary disease--a matched case control study.

We compared survival patterns in 61 medically treated and 78 surgically treated patients at a Japanese community hospital. The 2 groups were matched for presence of significant 3 vessel disease, resting ejection fraction of more than 40%, a bypassable left anterior descending artery, sex, and age. All surgical patients received saphenous vein grafts. The patients treated surgically had better 5 and 9 years survival rates than the medically treated patients (93% and 85% vs 74% and 55%, respectively; p < 0.01 by Cox-Mantel analysis). Five and 9 years rates of absence of ischemic events (non-fatal myocardial infarction and primary cardiac death) were also better in the surgical group than the medical group (92% and 87% vs 66% and 52%, respectively; p < 0.001). Of the surgically treated patients, 5 died perioperatively, 3 had late cardiac deaths and 2 had a nonfatal infarction. Among the medically treated patients, 16 had cardiac deaths, and 6 had non-fatal infarctions. Although our study was non-randomized, we have shown an advantage for surgical treatment of patients with 3-vessel coronary disease.

Aged↗
PubMed2003

[Recanalization by percutaneous coronary intervention in occlusion of all coronary vessels].

The utility of coronary intervention in the treatment of multivessel coronary disease with complex morphology and damage to the myocardium remains controversial. What is certain is that drug treatment is often not adequate and surgical revascularization not always possible. A patient with occlusion of all coronary vessels who underwent a multivessel intervention is presented. Multivessel intervention can improve the left ventricular function and appreciably increase the performance of the patient. In similar cases, consideration should be given to percutaneous coronary intervention as an alternative to bypass surgery.

Angioplasty, Balloon, Coronary↗
PubMed2003

Coronary vessel development: a unique form of vasculogenesis.

Development of the coronary vascular system is an interesting model in developmental biology with major implications for the clinical setting. Although coronary vessel development is a form of vasculogenesis followed by angiogenesis, this system uses several unique developmental processes not observed in the formation of other blood vessels. This review summarizes the literature that describes the development of the coronary system, highlighting the unique aspects of coronary vessel development. It should be noted that many of the basic mechanisms that govern vasculogenesis in other systems have not been analyzed in coronary vessel development. In addition, we present recent advances in the field that uncover the basic mechanisms regulating the generation of these blood vessels and identify areas in need of additional studies.

Animals↗
PubMed1996

Comparison between positron emission tomography myocardial perfusion imaging and intracoronary Doppler flow velocity measurements at rest and during cold pressor testing in angiographically normal coronary arteries in patients with one-vessel coronary artery disease.

With use of invasive methods, coronary endothelial function is generally studied by examining the response of epicardial coronary arteries to intracoronary administered acetylcholine or to cold pressor testing. Because invasive methods have substantial inherent limitations, studies should attempt to evaluate coronary endothelial function noninvasively. This study examines a noninvasive technique for endothelium-related coronary stress testing. In myocardial regions supplied by nonstenotic coronary arteries, we compared positron emission tomography (PET) myocardial perfusion imaging with intracoronary Doppler flow velocity measurements during endothelium-related stress testing. PET perfusion was examined at rest and during cold pressor testing in 10 patients with 1-vessel coronary artery disease. In nonstenotic coronary arteries, flow velocity measurements were obtained at rest, during cold pressor testing, and during intracoronary administered acetylcholine. Perfusion and flow velocity responses and stress/rest ratios were compared between the techniques during the various circumstances. Positive correlations were found between: (1) cold pressor Doppler flow velocity responses and acetylcholine Doppler flow velocity responses (r = 0.84, SEE = 0.19, p = 0.003); (2) cold pressor PET perfusion responses and cold pressor Doppler flow velocity responses (r = 0.70, SEE = 0.17, p = 0.02); and (3) cold pressor PET perfusion responses and acetylcholine Doppler flow velocity responses (r = 0.62, SEE = 0.19, p = 0.05). These results suggest that in angiographically normal coronary arteries, both the flow velocity and the perfusion responses during cold pressor testing may be related to the response to acetylcholine.

Acetylcholine↗
PubMed1992

Retroviral analysis of cardiac morphogenesis: discontinuous formation of coronary vessels.

Cellular progenitors of the coronary vasculature are believed to enter the chicken heart during epicardial morphogenesis between stages 17 and 27 (days 3-5) of egg incubation. To trace cells which give rise to the coronary arteries in vivo, we applied retroviral cell tagging procedures and analyzed clonal populations of vascular smooth muscle, endothelium, and connective tissue in the hearts of post-hatch chickens. Our data provide direct proof that (i) vascular smooth muscle progenitors begin to enter the heart at stage 17, substantially after the heart begins propulsive contractions; (ii) cardiac myocytes, vascular smooth muscle, perivascular fibroblasts, and coronary endothelial cells all derive from independent precursors when these cells migrate into the heart; (iii) endothelial cells of the coronary vessels have a different clonal origin than endothelial cells of the endocardium; (iv) coronary arteries form by the coalescence of discontinuous colonies (i.e., in situ vasculogenesis), each derived from a founder cell tagged at the time of retroviral injection (stages 17-18); and (v) coronary arteries contain discrete segments composed of "polyclones." These studies indicate the feasibility of gene targeting to coronary progenitors through the use of recombinant retroviruses.

Animals↗
PubMed1997

Quantitative angiographic analysis of PTCA-induced coronary vasoconstriction in single-vessel coronary artery disease.

Quantitative coronary angiography was applied to investigate the degree and extent of coronary vasoconstriction following percutaneous transluminal coronary angioplasty (PTCA) in single-vessel disease of segments distal to the PTCA site (n = 46) and of control segments in nonmanipulated vessels (n = 33) before PTCA, 15 minutes after PTCA, and again 10 minutes after 10 mg sublingual isosonbide dinitrate (ISDN) in 46 patients receiving neither nitrates nor calcium channel blockers prior to PTCA. Furthermore, the degree of coronary vasoconstriction was compared with ergonovine-induced vasoconstriction (n = 8) as well as in patients with and without restenosis during follow-up angiography 4 months later. PTCA induced a moderate, but significant, vasoconstriction in both distal and control segments, with a reduction in coronary diameter from 2.34 +/- 0.58 to 2.26 +/- 0.55 mm (P = 0.011) and from 2.70 +/- 0.62 to 2.60 +/- 0.65 mm (P = 0.004), respectively. No correlation between the degree of vasoconstriction on the one side and lesion severity and PTCA-induced mechanical stretch, judged by the sum of the products of inflation pressure and time, on the other side was found. Vasoconstriction was within the limits achievable with the potent vasoconstrictor ergonovine and did not differ in patients with or without restenosis. ISDN led to a significant vasodilatation in all segments. In conclusion, coronary vasoconstriction following PTCA is present in the coronary tree in a rather diffuse way. It is not associated with stenosis severity or PTCA-induced mechanical stretch, suggesting a complex underlying mechanism. ISDN-reversible vasoconstriction was within the limits achievable with ergonovine and did not differ with regard to restenosis.

Administration, Sublingual↗
PubMedDate not supplied

[Features of antioxidative homeostasis in different lipid metabolic changes in patients with coronary vessel arteriosclerosis].

In patients with atherosclerosis of coronary vessels, particular features of antioxidative homeostasis which reflect dynamic balance between reactions of peroxide oxidation of lipids and those of the antioxidant system were studied. Different mechanisms have been revealed of maintenance of antioxidative homeostasis in patients with atherosclerosis of coronary vessels depending on the type of lipid abnormalities. In calculating the coefficient of significance (Kj) formulas have been deduced of significant parameters of antioxidative homeostasis in those atherosclerotic patients revealing normolipidemia, dyslypoproteidemia, type II and IV, that can be used as additional diagnostic and prognostic criteria for the course of the atherosclerotic process.

Adult↗
PubMed1989

Coronary angioplasty and left ventricular function in single vessel coronary artery disease.

Left ventricular function was investigated in 86 patients with single vessel coronary artery disease before and three to six months after successful angioplasty. Before angioplasty thallium-201 perfusion scintigraphy and technetium-99m gated equilibrium ventriculography in most patients showed that stress testing (exercise and ice water stimulation and isometric handgrip respectively) induced myocardial perfusion defects that were associated with a mean (SD) drop in left ventricular ejection fraction from 64 (6)% to 56 (7)%. After angioplasty there was residual coronary stenosis of less than or equal to 20% of the diameter of the vessel in 78 patients (group 1) and of between 20 and 50% in eight patients (group 2). After the procedure the perfusion defects seen during stress resolved in 86% of group 1 and in 87% of group 2. Despite the apparent improvement in myocardial perfusion left ventricular dysfunction persisted in group 2--that is during stress the left ventricular ejection fraction fell from 65% (6) to 56% (5). In group 1, on the other hand, the improvement in myocardial perfusion was associated with significant improvement in left ventricular function with a normal increase in ejection fraction from 63 (5) at rest to 67 (6) during stress. Radionuclide studies, one to six weeks after angioplasty in 30 group 1 patients showed continuing left ventricular decompensation during stress in nine (30%) of them despite correction of perfusion defects. But reinvestigation three to six months after the procedure showed recovery of left ventricular function with an increase in ejection fraction from 66 (5) at rest to 69 (7) during stress. These data indicate that coronary angioplasty procedures that give a residual stenosis of </= 20% improve myocardial perfusion and the response of the left ventricle to stress. The functional improvement may be delayed for up to three months, however, possibly because arterial healing at the angioplasty site is delayed. On the other hand, when the residual stenosis is between 21 and 50% of the diameter of the vessel subclinical left ventricular dysfunction during stress may persist indefinitely.

Adult↗
PubMed2000

[Diffuse left ventricular hypokinesis mimicking dilated cardiomyopathy with multi-vessel coronary vasospasm].

We investigated 7 patients with multi-vessel coronary vasospasm (> or = 75%) and diffuse left ventricular hypokinesis by coronary angiography and echocardiography. Four patients were male and 3 were female and mean +/- SD age was 63.0 +/- 11.2 years. Chief complaints were dyspnea in 3 patients, and chest pain, appetite loss, palpitation and general fatigue in one each. New York Heart Association functional classification was I in one patient, II in 5 and III in one. Mean heart rate was 73.9 +/- 11.6 beats/min. Initial echocardiography showed left ventricular end-diastolic diameter (LVDd) 54.4 +/- 5.5 mm, left ventricular end-systolic diameter (LVDs) 43.7 +/- 4.8 mm and percentage fractional shortening (%FS) 19.7 +/- 2.6%. The left ventricle was not remarkably enlarged despite poor contraction. Coronary vasospasm was induced after acetylcholine injection into the right coronary artery in 6 patients, left anterior descending artery in 7 and circumflex artery in 5. Four patients developed three-vessel coronary vasospasm. Three patients underwent endomyocardial biopsy which showed non-specific mild fibrosis. They were treated with nitrates and/or Ca-antagonists to prevent coronary vasospasm. Follow-up echocardiography was performed in 6 patients after 8.5 +/- 6.6 months. Echocardiography revealed marked improvement in left ventricular contraction (LVDd 49.7 +/- 4.6 mm, LVDs 35.8 +/- 4.4 mm, p < 0.05; %FS 27.9 +/- 4.5%, p < 0.05). These data suggested that left ventricular dilation was not prominent despite the poor contractility in patients with multi-vessel coronary vasospasm and diffuse left ventricular hypokinesis. The left ventricular dysfunction might be hibernating myocardium produced by multiple episodes of coronary vasospasm. Anti-vasospastic agents were effective in these patients.

Acetylcholine↗
PubMed1997

[Intracoronary dipyridamole reduces the incidence of acute coronary vessel occlusion in percutaneous transluminal coronary angioplasty--a prospective randomized study].

Even in the era of coronary stenting, acute coronary artery occlusion continues to represent a significant limitation of percutaneous transluminal coronary angioplasty (PTCA). Despite application of heparin and aspirin, abrupt vessel closure still occurs in 2-8%, depending on the definition applied. Especially patients receiving PTCA for acute coronary syndromes are at high risk for abrupt vessel closure. The formation of an intracoronary thrombus plays a central role in the pathogenesis of abrupt vessel closure. Dipyridamole induces dilatation of coronary arteries and prevents platelet aggregation by a mechanism that differs from that of aspirin. The primary purpose of the study was to evaluate whether adjunctive local intracoronary therapy with dipyridamole could reduce the incidence of coronary artery occlusion following PTCA. Secondary endpoints were defined as myocardial infarction, necessity for bypass grafting, and death. In 939 PTCA procedures performed for stable angina and in 155 angioplasty procedures for acute coronary syndromes (unstable angina, acute myocardial infarction), patients were randomized to receive conventional pretreatment consisting of heparin 15,000 I.E. and aspirin 500 mg i.v. or additional intracoronary infusion of dipyridamole (0.5 mg/kg body weight). Dipyridamole was applied in 550 interventions (455 interventions in men, 95 interventions in women, age = 59.2 +/- 8.4; 74 emergency procedures); conventional pretreatment was performed in 544 interventions (444 interventions in men, 100 interventions in women, age 58.3 +/- 7.9; 81 emergency procedures). Intracoronary application of dipyridamole resulted in a significant reduction in the incidence of abrupt vessel closure following PTCA. This significant reduction was observed in patients presenting with stable ischemia as well as in patients receiving PTCA for acute coronary syndromes. Concerning secondary end points, intracoronary application of dipyridamole did not affect the need for bypass grafting or the incidence of death following PTCA. Intracoronary application of dipyridamole was associated with a reduction in the incidence of myocardial infarction following PTCA which, however, failed to reach significance.

Adult↗
PubMed2002

Coronary collaterals during single-vessel coronary angioplasty: effects of nitroglycerin.

BACKGROUND: Although the protective role of collaterals in coronary artery disease (CAD) is well known, the influence of drugs on collateral function remains controversial. HYPOTHESIS: We aimed to investigate prospectively the prevalence of spontaneously visible and recruitable coronary collaterals in consecutive patients with single-vessel CAD and the effect of systemic administration of nitroglycerin on these types of collaterals during percutaneous transluminal coronary angioplasty (PTCA). METHODS: Ipsi- and contralateral coronary artery contrast injections were performed before and during PTCA. Simultaneously with balloon occlusion, we measured coronary artery occlusion pressure via the balloon catheter. All measurements were repeated after administration of 0.5 mg of nitroglycerin intravenously. RESULTS: Of 101 consecutive patients, 24% had spontaneously visible and 30% had recruitable collaterals. Contralateral collaterals were five times more frequent than ipsilateral collaterals. Presence of collaterals was highly associated with the degree of coronary stenosis. Coronary occlusion pressure was higher in patients with than in those without collaterals. Collaterals prevented pain and ischemia during PTCA, and in this respect spontaneously visible collaterals were more effective than recruitable collaterals. There was no effect of systemic administration of nitroglycerin on appearance or occlusion pressure of coronary collaterals. CONCLUSION: Coronary collaterals were found in more than half of patients with single-vessel CAD, as the prevalence of recruitable collaterals was slightly higher than that of spontaneously visible collaterals. Nitroglycerin did neither recruit nor augment coronary collaterals.

Adult↗
PubMedDate not supplied

Age-related changes in catecholaminergic nerve fibers of rat heart and coronary vessels.

BACKGROUND: Age-related changes of catecholaminergic nerve fibers supplying the myocardium and the coronary vessels were studied in adult and in old rats. OBJECTIVE: The purpose of this study was to investigate whether there are quantitative changes in myocardial and/or coronary catecholaminergic nerve fibers and related neurotransmitters. METHODS: Samples of myocardium and/or coronary vessels were studied by means of glyoxylic acid induced fluorescence, aldehyde-induced fluorescence, and neuropeptide Y immunoreactivity. All morphological results were submitted to quantitative analysis of images. Biochemical dosage of proteins and of norepinephrine was also performed, and morphological data were compared with biochemical ones. Finally, all data were subjected to statistical analysis. RESULTS: Our findings are indicative of an age-related decrease of all types of fluorescent sympathetic nerve fibers in rat heart and coronary arteries. Moreover, our data show that aging induces a strong decrease of norepinephrine levels in tissue homogenates of rat heart and coronary vessels. The majority of the catecholaminergic nerve fibers that show strong age-related changes are not contiguous with contractile cells of myocardium and/or of vascular wall. In fact, these fibers are located in adventitial (or epicardial) and in endothelial (or endocardial) layers. CONCLUSION: The decrease of the catecholaminergic innervation of heart and coronary vessels of old rats can be in close relationships to the poor cardiac and/or coronary functions observed in old animals.

Aging↗
PubMed2000

Multi-vessel coronary stenting--procedural results and late clinical outcomes: a comparison with single-vessel stenting.

The purpose of this study was to assess the 1-year clinical outcome of patients with multi-vessel coronary artery disease (CAD) who underwent coronary stenting, and to compare the results with single-vessel coronary stenting carried out during the same period. We evaluated the in-hospital and 12-month clinical outcomes [death, Q-wave myocardial infarction (MI) and repeat revascularization rates at one year] in 384 consecutive patients treated with coronary stents in 2 (92% of patients) or 3 of the native coronary arteries and compared the outcome to 624 consecutive patients undergoing stenting in a single coronary artery between January 1, 1997 and January 31, 1999. The overall procedural success was obtained in 99% of patients with 2- or 3-vessel stenting and 98% of patients with single-vessel stenting. Procedural complications were similar (2.9% vs 2.6%; p = 0.12). During follow-up, target lesion revascularization was 16% in multi-vessel and 14% in single-vessel stenting (p = 0.38) and repeat revascularization was also similar for both groups (19% vs. 20%; p = 0.73). There was no difference in death (0.8% vs. 1.3%; p = 0.31) and Q-wave MI (0.7% vs. 1.4%; p = 0. 16) in the 2 groups. Overall cardiac event-free survival was similar for both groups (76% vs. 78%; p = 0.54). Multi-vessel stenting in carefully selected patients in our experience had a high procedural success with very low complication rates. The one-year clinical outcomes were acceptable and were similar to the results of single-vessel stenting.

Angioplasty, Balloon, Coronary↗
PubMed1997

Exercise electrocardiogram and single vessel coronary artery disease.

The aim of this study was to assess the efficiency of exercise tests in identifying ischaemia in the territories supplied by the three main coronary arteries. We prospectively analysed 578 patients with single vessel coronary disease (> 50% stenosis in one vessel and completely normal other vessels). Patients with single vessel coronary artery disease were divided into three groups: patients with significant left anterior coronary artery disease (group 1, n = 234); patients with significant right coronary artery disease (group 2, n = 201); patients with significant left circumflex disease (group 3, n = 143). Our study, which is the largest prospective study of patients with angiographically documented single vessel coronary artery disease, suggests that the exercise electrocardiogram is a poor predictor of circumflex coronary artery ischaemia. In addition, the site of ST depression identified from the electrocardiogram was a poor predictor of the site of myocardial ischaemia. No single lead could distinguish between the three groups and the location of coronary stenosis could not be predicted by location of ST depression.

Coronary Disease↗