Circulation, Vol 89, 164-168, Copyright © 1994 by American Heart Association
JS Landzberg, JD Parker, DF Gauthier and WS Colucci
BACKGROUND: The role of cholinergic pathways in modulating left ventricular
contractile function in humans is not known. This study evaluated the
effect of a cholinergic agonist (acetylcholine) and antagonist (atropine)
on basal and beta-adrenergically stimulated left ventricular contractile
function in normal subjects and subjects with denervated hearts after
cardiac transplantation. METHODS AND RESULTS: Six subjects with normal left
ventricular function and seven subjects who were 1 to 3 years after cardiac
transplantation were studied. Acetylcholine, atropine, and the
beta-adrenergic agonist dobutamine were infused via the left main coronary
artery, and changes in left ventricular contractile function were assessed
by measurement of peak +dP/dt. Intracoronary dobutamine increased +dP/dt by
70 +/- 15% and 66 +/- 20% in the normal subjects and transplant recipients,
respectively. Intracoronary acetylcholine and atropine alone each had no
effect on left ventricular +dP/dt in either normal subjects or transplant
recipients. The concurrent infusion of acetylcholine with dobutamine
reduced the response to dobutamine by 66 +/- 10% and 79 +/- 9% in normal
subjects and transplant recipients, respectively. The concurrent infusion
of atropine with dobutamine potentiated the response to dobutamine by 25
+/- 7% in normal subjects but had no effect in transplant recipients.
CONCLUSIONS: Stimulation and inhibition of cholinergic receptors in the
human heart can modulate the positive inotropic response to beta-adrenergic
stimulation.
ARTICLES
Effects of intracoronary acetylcholine and atropine on basal and dobutamine-stimulated left ventricular contractility
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
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