Circulation, Vol 82, 1169-1173, Copyright © 1990 by American Heart Association
JM McLenachan, J Vita, DR Fish, CB Treasure, DA Cox, P Ganz and AP Selwyn
Intracoronary acetylcholine produces endothelium-dependent dilation of
normal coronary arteries and paradoxical constriction of atherosclerotic
vessels. Regional differences in endothelium-dependent vasomotion, however,
have not been studied in relation to the nonuniform development of
atherosclerosis. We compared the vasomotor response to increasing doses of
acetylcholine of angiographically smooth coronary artery segments prone to
atherosclerosis (coronary branch points) with segments remote from branch
points (straight segments). In patients with entirely smooth coronary
arteries and a dilator response to acetylcholine (group 1, n = 7), branch
points and straight segments demonstrated equal and significant
dose-dependent dilation to acetylcholine (14.7 +/- 8.9% and 12.3 +/- 12.7%,
respectively; p identical to NS). In patients with early atherosclerosis as
manifest by luminal coronary irregularities, the lowest dose of
acetylcholine (10(-8) M) produced constriction at branch points and slight
dilation at straight segments (-6.3 +/- 7.4% vs. +2.2 +/- 7.3%, p less than
0.05). At higher doses of acetylcholine, both branch point and straight
segments constricted, but constriction remained more pronounced at branch
points. Both branch point and straight segments, however, retained the
ability to dilate to the non- endothelium-dependent agent, nitroglycerin.
In a third group of patients with angiographically entirely smooth coronary
arteries but without dilation to acetylcholine, constriction to
acetylcholine again occurred first at branch points. Thus, coronary branch
points demonstrate increased sensitivity to acetylcholine-induced
constriction in patients with angiographic evidence of early coronary
atherosclerosis and in middle-aged patients with smooth coronary arteries.
These segments, however, retain the ability to dilate to nitroglycerin.
Whether this early evidence of defective endothelium- dependent
vasodilation predicts the later development of occlusive atherosclerosis is
not yet known.
ARTICLES
Early evidence of endothelial vasodilator dysfunction at coronary branch points
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
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