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Circulation, Vol 73, 865-876, Copyright © 1986 by American Heart Association
JE Gage, OM Hess, T Murakami, M Ritter, J Grimm and HP Krayenbuehl
To study the vasomotility of normal and diseased coronary arteries during
dynamic exercise, symptom-limited supine bicycle exercise during cardiac
catheterization was performed by 18 patients with classic angina pectoris.
The cardiovascular response was assessed by hemodynamic measurements and
computer-assisted determination of normal and stenotic coronary artery
luminal areas from biplane coronary angiograms made before, during, and
after exercise. After baseline measurements were recorded, 12 patients
(group 1) performed bicycle exercise for 3.4 min (mean), reaching a maximum
workload of 81 W (mean); at the end of exercise they received 1.6 mg
sublingual nitroglycerin. After measurements at rest in six other patients
(group 2), 0.1 mg intracoronary nitroglycerin was given, followed by
exercise (3.8 min, 96 W; NS) and sublingual nitroglycerin as in group 1.
During exercise in group 1, luminal area of the coronary stenosis decreased
to 71% of resting levels (p less than .001), while area of the normal
coronary artery increased to 123% of control (p less than .001). After
sublingual nitroglycerin at the end of exercise, area of the normal vessel
further increased to 140% of control (p less than .001), while luminal area
of the stenosis dilated to 112% of resting levels (p less than .001 vs
exercise, NS vs rest). Pretreatment with intracoronary nitroglycerin
increased both normal (121%; p less than .05) and stenotic (122%; p less
than .05) luminal areas, while preventing the previously observed narrowing
of stenosis during exercise (114%; NS). Exercise resulted in a similar
heart rate-systolic pressure product and caused angina pectoris in
two-thirds of the patients in each group. However, patients pretreated with
intracoronary nitroglycerin (group 2) had a lower mean pulmonary arterial
pressure during maximum exercise (35 mm Hg) than those patients (group 1)
not receiving pretreatment (47 mm Hg; p less than .001). Group 2 patients
reached a percentage of their predicted work capacity (65%) that was about
the same as that during previous upright bicycle exercise (71%; NS), while
group 1 patients had a significantly lower work capacity (51% of predicted)
than that before catheterization (82%; p less than .001). Hence, narrowing
of coronary artery stenosis during dynamic exercise is attributable to
active vasoconstriction due to its reversibility by preexercise
intracoronary nitroglycerin. Patients who did not experience narrowing of
stenosis during exercise (group 2) had less evidence of myocardial ischemia
(lower mean pulmonary arterial pressure) and maintained their work
capacity.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Vasoconstriction of stenotic coronary arteries during dynamic exercise in patients with classic angina pectoris: reversibility by nitroglycerin
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