(Circulation. 1999;99:2090-2097.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Augmented 
-Adrenergic Constriction of Atherosclerotic Human Coronary Arteries
From the Departments of Cardiology and Pathophysiology (G.H.), Center of Internal Medicine, University of Essen, Germany.
Correspondence to Dietrich Baumgart, MD, Universitätsklinikum Essen, Abteilung für Kardiologie, Hufelandstraße 55, 45122 Essen, Germany. E-mail dbaum3{at}t-online.de
Background—Although adrenergic
activation plays a major role in the initiation of experimental
myocardial ischemia, the significance of 
-adrenergic
coronary constriction in humans has been questioned. The
present study assessed the impact of selective -adrenergic
receptor activation in patients with normal or atherosclerotic
coronary arteries.
Methods and Results—In 39 patients, coronary blood flow
(CBF, mL/min) was determined from combined angiography and Doppler
measurements. In 8 patients with normal coronary arteries
(group 1) and 9 with single coronary artery stenosis
(group 2), doses of 1, 2.5, 5, and 10 mg IC of the
1-agonist methoxamine (M) were injected.
Identical doses of the 2-agonist BHT933 (B) were
injected in 8 patients with normal coronary arteries (group 3)
and 8 with single stenosis (group 4). In 6 additional patients
with single stenosis (group 5), aortocoronary sinus
lactate differences were measured in response to M and B. CBF remained
unchanged in group 1. In contrast, CBF was decreased dose-dependently
in group 2, with a maximum at 10 mg M (39.0±9.4 versus 15.2±7.0). In
groups 3 and 4, CBF was also decreased dose-dependently, with a maximum
at 10 mg B (63.3±24.8 versus 49.1±27.9 and 41.5±19.0 versus
12.7±8.0, respectively). In group 5, there was more net lactate
production with B than with M (-0.34±0.11 versus
-0.04±0.09 mmol/L).
Conclusions—In normal coronary arteries,
1-adrenergic activation does not reduce CBF, whereas
2-adrenergic activation reduces CBF by microvascular
constriction. Both 1- and 2-adrenergic
epicardial and microvascular constriction are augmented by
atherosclerosis and can induce myocardial
ischemia.
Key Words: coronary disease • angiography • ultrasonics
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