(Circulation. 1997;96:2171-2177.)
© 1997 American Heart Association, Inc.
Articles |
Phentolamine Prevents Adaptation to Ischemia During Coronary Angioplasty
Role of 
-Adrenergic Receptors in Ischemic Preconditioning
From the Servizio Speciale di Diagnosi e Cura di Emodinamica (F.T., A.G., F.V., A.S.G., R.De P., L.C., P.A.G.), Divisione di Cardiochirurgia, Università di Roma Tor Vergata, European Hospital; and Istituto di Cardiologia (F.C.), Università Cattolica del Sacro Cuore, Rome, Italy.
Correspondence to Dr Fabrizio Tomai, Divisione di Cardiochirurgia, Università di Roma Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy.
Background Experimental studies indicate that
-adrenergic receptors are involved in ischemic
preconditioning. Their role in humans is unknown.
Methods and Results Eighteen patients undergoing angioplasty for an isolated stenosis of the left anterior descending coronary artery were randomized to receive intravenous infusion of phentolamine or placebo during the procedure. Intracoronary ECG and cardiac pain were determined at the end of the first two balloon inflations. Average peak velocity in the contralateral coronary artery during balloon occlusion, an index of collateral recruitment, was also assessed by using a Doppler guide wire. In both phentolamine- and placebo-treated patients, average peak velocity significantly increased from baseline to the end of the first inflation (P<.01), but it did not show any further increase during the second inflation. In phentolamine-treated patients, ST-segment changes and cardiac pain severity during the second inflation were similar to those observed during the first inflation (13±9 versus 12±8 mm, P=NS, and 51±34 versus 54±32 mm, P=NS, respectively), whereas in placebo-treated patients, they were significantly less (6±4 versus 13±7 mm, P<.01, and 26±20 versus 49±22 mm, P<.05, respectively).
Conclusions The adaptation to ischemia observed in
humans after two sequential coronary balloon inflations is
abolished by phentolamine and is independent of collateral
recruitment. Thus, it occurs due to ischemic preconditioning
and is, at least in part, mediated by -adrenergic receptors.
Key Words: angioplasty • receptors, adrenergic, alpha • collateral circulation
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