Circulation, Vol 81, 772-779, Copyright © 1990 by American Heart Association
CB Treasure, JA Vita, DA Cox, RD Fish, JB Gordon, GH Mudge, WS Colucci, MG Sutton, AP Selwyn and RW Alexander
Dilator reserve of the coronary microvasculature is diminished in patients
with dilated cardiomyopathy. Although increased extravascular compressive
forces, tachycardia, and increased myocardial mass can explain some
impairment, recent evidence suggests the possibility of intrinsic
microvascular disease. We tested the hypothesis that impairment of
endothelium-dependent dilation of the microvasculature could be a
contributing mechanism. We infused the endothelium-dependent dilator
acetylcholine (Ach) (10(-8) to 10(-6) M) and the smooth muscle vasodilator
adenosine (AD) (10(-6) to 10(-4) M) into the left anterior descending
coronary artery in eight patients with dilated cardiomyopathy (mean
ejection fraction, 28%) and seven controls (atypical chest pain). Small
vessel resistance was assessed by measuring coronary blood flow (CBF) at
constant arterial pressure with a Doppler velocity catheter (corrected for
cross-sectional area by angiography). With Ach, control patients increased
CBF 232 +/- 40% (mean +/- SEM), whereas CBF did not significantly change in
cardiomyopathy patients (41 +/- 24%) (p less than 0.0001, control vs.
cardiomyopathy). With AD, control patients increased CBF 422 +/- 56% and
cardiomyopathy patients increased CBF 268 +/- 43% (p = 0.13). An index of
the proportion of coronary flow reserve attributable to
endothelium-dependent vasodilation was obtained by standardizing each
patient's Ach dose response to his maximal AD flow response. In seven
control patients receiving both Ach and AD, 56 +/- 9% of the maximal AD
flow response was attained with the endothelium-dependent vasodilator Ach,
whereas in seven cardiomyopathy patients receiving both Ach and AD, only 23
+/- 14% of the maximal AD response was attained (p less than
0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Endothelium-dependent dilation of the coronary microvasculature is impaired in dilated cardiomyopathy
Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Boston, MA 02115.
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