Circulation, Vol 87, 1928-1937, Copyright © 1993 by American Heart Association
GG Neri Serneri, M Boddi, L Arata, C Rostagno, P Dabizzi, M Coppo, M Bini, S Lazzerini, A Dagianti and GF Gensini
BACKGROUND. Inferential evidence suggests that silent ischemia might be
related to sympathetic activity. Study of [3H]norepinephrine kinetics is a
suitable tool to assess the regional sympathetic activity. This method was
applied to investigate whether silent myocardial ischemia in unstable
angina is related to and depends on cardiac sympathetic overactivity.
METHODS AND RESULTS. Patients with active unstable angina were compared
with patients with inactive unstable angina, stable effort angina, and
controls. Silent myocardial ischemia was evaluated by three 24-hour Holter
monitoring periods on alternate days, and [3H]norepinephrine kinetics was
assessed under rest conditions and following the cold pressor test.
Simultaneously, catecholamine concentrations were measured in the aortic,
coronary sinus, and peripheral venous blood. Different than the other
groups (p = 0.0013), in patients with active unstable angina, the majority
of silent ischemic episodes occurred without increase in heart rate. These
patients had a positive coronary sinus-aorta norepinephrine gradient, both
at rest and following the cold pressor test. [3H]Norepinephrine kinetics
demonstrated an increased selective cardiac spillover, both at rest and,
even more, after the cold pressor test. Reduced cardiac [3H]norepinephrine
extraction also was found. A significant relation was found between the
number of ischemic episodes or the overall duration of silent ischemia and
norepinephrine spillover, both at rest and following cold application.
CONCLUSIONS. During the acute phase of unstable angina (but not in the
quiescent phase or in stable effort angina), a disorder in cardiac
norepinephrine handling occurs. This results in a reflex cardiac
sympathetic overactivity that plays a major role in the occurrence of
silent myocardial ischemia.
ARTICLES
Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling
Center for Heart and Thrombosis Research, University of Florence, Italy.
This article has been cited by other articles:
 |
|
 |
|
  G. Barletta, S. Del Pace, M. Boddi, R. Del Bene, C. Salvadori, B. Bellandi, M. Coppo, E. Saletti, and G. F. Gensini Abnormal coronary reserve and left ventricular wall motion during cold pressor test in patients with previous left ventricular ballooning syndrome Eur. Heart J., December 2, 2009; 30(24): 3007 - 3014. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. G. Neri Serneri, M. Boddi, P. A. Modesti, M. Coppo, I. Cecioni, T. Toscano, M. L. Papa, M. Bandinelli, G. F. Lisi, and M. Chiavarelli Cardiac Angiotensin II Participates in Coronary Microvessel Inflammation of Unstable Angina and Strengthens the Immunomediated Component Circ. Res., June 25, 2004; 94(12): 1630 - 1637. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Svorkdal Treatment of Inoperable Coronary Disease and Refractory Angina: Spinal Stimulators, Epidurals, Gene Therapy, Transmyocardial Laser, and Counterpulsation Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2004; 8(1): 43 - 58. [Abstract] [PDF]
|
|
|
|
|
|
G. G. Neri Serneri, M. Boddi, P. A. Modesti, I. Cecioni, M. Coppo, M. L. Papa, T. Toscano, A. Marullo, and M. Chiavarelli Immunomediated and Ischemia-Independent Inflammation of Coronary Microvessels in Unstable Angina Circ. Res., June 27, 2003; 92(12): 1359 - 1366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. G. N. Serneri, P. A. Modesti, M. Boddi, I. Cecioni, R. Paniccia, M. Coppo, G. Galanti, I. Simonetti, S. Vanni, L. Papa, et al. Cardiac Growth Factors in Human Hypertrophy : Relations With Myocardial Contractility and Wall Stress Circ. Res., July 9, 1999; 85(1): 57 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Olausson, H. Magnusdottir, L. Lurje, B. Wennerblom, H. Emanuelsson, and S.-E. Ricksten Anti-Ischemic and Anti-Anginal Effects of Thoracic Epidural Anesthesia Versus Those of Conventional Medical Therapy in the Treatment of Severe Refractory Unstable Angina Pectoris Circulation, October 7, 1997; 96(7): 2178 - 2182. [Abstract] [Full Text]
|
|
|
|
|
|
B. Rundqvist, M. Elam, Y. Bergmann-Sverrisdottir, G. Eisenhofer, and P. Friberg Increased Cardiac Adrenergic Drive Precedes Generalized Sympathetic Activation in Human Heart Failure Circulation, January 7, 1997; 95(1): 169 - 175. [Abstract] [Full Text]
|
|
|
|
|
|
G. G. N. Serneri, M. Boddi, M. Coppo, T. Chechi, N. Zarone, M. Moira, L. Poggesi, M. Margheri, and I. Simonetti Evidence for the Existence of a Functional Cardiac Renin-Angiotensin System in Humans Circulation, October 15, 1996; 94(8): 1886 - 1893. [Abstract] [Full Text]
|
|
|
|
 |
|
 G. Piccirillo, F. L. Fimognari, E. Santagada, M. R. Munizzi, E. Viola, G. Monteforte, C. Bucca, M. Durante, C. Di Gioacchino, S. Tarantini, et al. Power Spectral Analysis of Heart Rate in Elderly Hypertensive Subjects With or Without Silent Coronary Disease Angiology, January 1, 1996; 47(1): 15 - 22. [Abstract] [PDF]
|
|
|
|
|
|
H. Lin and D. B. Young Opposing Effects of Plasma Epinephrine and Norepinephrine on Coronary Thrombosis In Vivo Circulation, February 15, 1995; 91(4): 1135 - 1142. [Abstract] [Full Text]
|
|
|
|
|
|
G. G. Neri Serneri, M. Boddi, P. A. Modesti, I. Cecioni, M. Coppo, L. Padeletti, A. Michelucci, A. Colella, and G. Galanti Increased Cardiac Sympathetic Activity and Insulin-Like Growth Factor-I Formation Are Associated With Physiological Hypertrophy in Athletes Circ. Res., November 23, 2001; 89(11): 977 - 982. [Abstract] [Full Text] [PDF]
|
|