Circulation, Vol 73, 444-451, Copyright © 1986 by American Heart Association
RF Wilson and CW White
An ideal coronary vasodilator for studying coronary flow reserve in humans
would rapidly produce maximal coronary vasodilation, be short acting to
permit repeated measurements, and not alter systemic hemodynamics. The two
commonly used vasodilators (dipyridamole and meglumine diatrizoate) do not
satisfy these criteria; meglumine diatrizoate does not produce maximal
hyperemia and dipyridamole has a long duration of effect (greater than 30
min). In this study we used a subselective coronary Doppler catheter to
measure the dose-response kinetics of a shorter acting vasodilator,
intracoronary papaverine. In 10 patients with normal coronary vessels, the
maximal vasodilator response to papaverine was compared with that to
intravenous dipyridamole (0.56 mg/kg infused over 4 min) and intracoronary
meglumine diatrizoate. The increase in coronary blood flow velocity after
the maximal dose of papaverine (4.8 +/- 0.4 peak/resting velocity ratio,
mean +/- SEM) was nearly identical to that seen after infusion of
dipyridamole (4.8 +/- 0.6) and was significantly greater than that after
meglumine diatrizoate (3.1 +/- 0.2, p less than .01). At maximal hyperemia,
mean arterial blood pressure fell 9 +/- 2% (mean +/- SEM) after
intracoronary papaverine, 8 +/- 4% after dipyridamole, and 3 +/- 3% after
meglumine diatrizoate. The dose-response kinetics of intracoronary
papaverine were studied in 13 patients with normal coronary arteries. In
the left coronary artery, maximal vasodilation (5.4 +/- 0.6) was achieved
with 8 mg in six of eight patients and with 12 mg in all patients. In the
right coronary artery, maximal vasodilation (4.8 +/- 0.7) was achieved with
6 mg in four or five patients and with 8 mg in all patients.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans
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