Abstract
In 29 patients (age 57 ± 9 yr; 17M, 12F) undergoing coronary angioplasty a perfusion catheter and Doppler guidewire were introduced respectively into the proximal and medial segment (of an artery with < 30% diameter stenosis. Selective intracoronary administration of papaverine (bolus of 7 mg), acetylcholine (continuous infusion 0.036, 0.36, 3.6 μg/ml) and isosorbide dinitrate (bolus of 3 mg) were sequentially performed. ECG, aortic blood pressure and blood flow velocity were continously measured. Mean diameter of a studied arterial segment was measured in baseline conditions, at the end of each infusion of acetylcholine (ACh) and at the peak of isosorbide dinitrate concentration with quantitative angiography (CAAS, Pie Data Medical). Local coronary blood flow was calculated from the time-averaged flow velocity (APV) and the cross-sectional area at the site of the Doppler sample volume. All the concentrations of ACh induced a significant vasoconstriction of the studied artery. At the maximal concentration of ACh all but 3 pts (90%) showed a reduction of cross-sectional area (-24 ± 20%) for the studied segment. APV showed a significant increase only with the two highest concentrations of ACh. Mean value of local coronary blood flow showed large variability depending on ACh concentration. In comparison to baseline it was significantly decreased during intracoronary infusion of 0.036 μg/ml and was stable during 0.36 μg/ml ACh. The highest concentration of ACh (3.6 μg/ml) caused significant increase of local coronary blood flow with the presence of a flow reduction in 10 pts (35%). Conclusion: ACh induces a significant coronary vasoconstriction in angiographically normal or minimally diseased arteries in patients with advanced ischemic heart disease. In patients with advanced ischemic heart disease the discrepancy between behaviours of coronary blood flow velocity and cross-sectional area of epicardial arteries during intracoronary infusions of ACh reflects the differences in response of conduit arteries and coronary resistance vessels to this substance.
| Original language | English |
|---|---|
| Pages (from-to) | 92-99 |
| Number of pages | 8 |
| Journal | Kardiologia polska |
| Volume | 40 |
| Issue number | 2 |
| Publication status | Published - 1994 |
| Externally published | Yes |
Keywords
- Coronary blood flow
- Intracoronary Doppler velocimetry
- Quantitative coronary angiography
- Vascular endothelium
