Quantitative Assessment of Coronary Vasoreactivity in Humans In Vivo
- 15 October 1995
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 92 (8), 2087-2094
- https://doi.org/10.1161/01.cir.92.8.2087
Abstract
Background Disturbances in vasomotor tone are closely linked to the development of atherosclerosis and play an integral part in the pathophysiology of myocardial ischemia in patients with coronary artery disease. Currently, evaluation of coronary vasomotor tone relies on assessment of luminal changes in response to vasoactive stimuli by quantitative angiography. Assessment of luminal changes, however, may be misleading because of the effects of geometric magnification induced by atherosclerotic wall thickening and differences in basal tone, which may obscure potential effects of vasoactive stimuli. Methods and Results Combining angiographic measurements of luminal changes with measurements of coronary wall architecture determined by intracoronary ultrasound, we calculated absolute coronary arterial vasomotor tone in 34 patients with angiographically normal or “minimally diseased” coronary arteries. Epicardial artery vasodilator capacity in response to intracoronary nitroglycerin decreased significantly with increasing atherosclerotic wall thickening. An inverse relation existed between local atherosclerotic plaque load and nitroglycerin-induced changes in vasomotor tone ( r =−.65, P <.0001) regardless of potential systematically operative factors. At the same time, basal vasomotor tone significantly decreased with increasing local atherosclerotic wall thickening ( r =−.38, P =.004). The vasomotor effects of acetylcholine, an endothelium-dependent vasodilator, were inversely related to wall thickening only in segments with very minor degrees of atherosclerosis, whereas no such relation was observed for epicardial artery segments with more advanced atherosclerotic wall thickening. In these segments, however, vasoreactivity to acetylcholine was closely correlated with basal vasomotor tone ( r =−.62, P =.0002). Conclusions Atherosclerosis is associated with impairment of the vasodilator response to both nitroglycerin and acetylcholine in epicardial arteries in vivo. Basal vasomotor tone appears to be the primary determinant of the altered coronary vasoreactivity in response to vasoactive stimuli.Keywords
This publication has 18 references indexed in Scilit:
- The endothelium as a target and mediator of cardiovascular diseaseEuropean Journal of Clinical Investigation, 1993
- The Pathogenesis of Coronary Artery Disease and the Acute Coronary SyndromesNew England Journal of Medicine, 1992
- Flow activates an endothelial potassium channel to release an endogenous nitrovasodilator.JCI Insight, 1991
- Low basal and stimulated release of nitric oxide in atherosclerotic epicardial coronary arteriesThe Lancet, 1990
- Intravascular ultrasound imaging: In vitro validation and pathologic correlationJournal of the American College of Cardiology, 1990
- Coronary vasomotion in response to sympathetic stimulation in humans: Importance of the functional integrity of the endotheliumJournal of the American College of Cardiology, 1989
- Arterial wall characteristics determined by intravascular ultrasound imaging: An in vitro studyJournal of the American College of Cardiology, 1989
- Compensatory Enlargement of Human Atherosclerotic Coronary ArteriesNew England Journal of Medicine, 1987
- Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress.Arteriosclerosis: An Official Journal of the American Heart Association, Inc., 1985
- Contribution of dynamic vascular wall thickening to luminal narrowing during coronary arterial constriction.Circulation, 1980