Coronary endothelial dysfunction in humans is associated with myocardial perfusion defects

被引:7
作者
Hasdai, D
Gibbons, RJ
Holmes, DR
Higano, ST
Lerman, A
机构
[1] MAYO CLIN & MAYO FDN,DIV CARDIOVASC DIS,ROCHESTER,MN 55905
[2] MAYO CLIN & MAYO FDN,DIV INTERNAL MED,ROCHESTER,MN 55905
关键词
coronary disease; angina; vasodilation; microcirculation; perfusion;
D O I
暂无
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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) mom to 10(-4) mol/L) into the left anterior descending coronary artery (LAD). Percent change in CAD (%Delta CAD) was measured by quantitative coronary angiography, and percent change in coronary blood flow (%Delta CBF) was calculated using intracoronary flow Doppler. Coronary endothelium-independent vasodilation was examined using intracoronary adenosine and nitroglycerin. Tc-99m 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 %Delta CAD and %Delta CBF by 24+/-5% and 241+/-46% in the LAD. In group 2, %Delta CAD decreased by 26+/-5%, but %Delta CBF increased by 54+/-17%. Tn group 3, perfusion defects were within the LAD territory, reflecting a decrease in %Delta CAD and %Delta 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.
引用
收藏
页码:3390 / 3395
页数:6
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