| Alpha-adrenergic blockade improves recovery of myocardial perfusion and function after coronary stenting in patients with acute myocardial infarction. | |
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MedLine Citation:
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PMID: 9927393 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: AMI reperfusion by thrombolysis does not improve TIMI flow and LV function. The role of infarct-related artery (IRA) stenosis and superimposed changes in coronary vasomotor tone in maintaining LV dysfunction must be elucidated. METHODS AND RESULTS: Forty patients underwent diagnostic angiography 24 hours after thrombolysis. Seventy-two hours after thrombolysis, the culprit lesion was dilated with coronary stenting. During angioplasty, LV function was monitored by transesophageal echocardiography. Percent regional systolic thickening was quantitatively assessed before PTCA, soon after stenting, 15 minutes after stenting, and after phentolamine 12 microg/kg IC (n=10), the alpha1-blocker urapidil 600 microg/kg IV (n=10), or saline (n=10). Ten patients pretreated with beta-blockers received urapidil 10 mg IC. Coronary stenting significantly improved thickening in IRA-dependent and in non-IRA-dependent myocardium (from 27+/-15% to 38+/-16% and from 40+/-15% to 45+/-15%, respectively). Simultaneously, TIMI frame count decreased from 39+/-11 and 40+/-11 in the IRA and non-IRA, respectively, to 23+/-10 and 25+/-7 (P<0.05). Fifteen minutes after stenting, thickening worsened in both IRA- and non-IRA-dependent myocardium (to 19+/-14% and 28+/-14%, P<0.05), and TIMI frame count returned, in both the IRA and non-IRA, to the values obtained before stenting. Phentolamine and urapidil increased thickening to 36+/-17% and 41+/-14% in IRA and to 48+/-11% and 49+/-17% in non-IRA myocardium respectively, and TIMI frame count decreased to 16+/-6 and to 17+/-5, respectively. Changes were attenuated with beta-blocker pretreatment. CONCLUSIONS: Our finding that alpha-adrenergic blockade attenuates vasoconstriction and postischemic LV dysfunction supports the hypothesis of an important role of neural mechanisms in this phenomenon. |
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Authors:
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L Gregorini; J Marco; M Koz?kov?; C Palombo; G B Anguissola; I Marco; M Bernies; B Cassagneau; A Distante; I M Bossi; J Fajadet; G Heusch |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 99 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1999 Feb |
Date Detail:
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Created Date: 1999-03-09 Completed Date: 1999-03-09 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 482-90 Citation Subset: AIM; IM |
Affiliation:
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Clinique Pasteur, Centre de Cardiologie Interventionelle, Toulouse, France. luisa.gregorini@unimi.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic alpha-Antagonists
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therapeutic use* Adrenergic beta-Antagonists / therapeutic use Aged Blood Flow Velocity / drug effects Coronary Angiography Coronary Circulation / drug effects* Coronary Vessels / drug effects, physiopathology* Female Humans Male Middle Aged Myocardial Infarction / drug therapy*, physiopathology, radiography, surgery Phentolamine / therapeutic use* Piperazines / therapeutic use* Receptors, Adrenergic, alpha / drug effects Stents* Vasoconstriction / drug effects Ventricular Function, Left / drug effects* |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic alpha-Antagonists; 0/Adrenergic beta-Antagonists; 0/Piperazines; 0/Receptors, Adrenergic, alpha; 34661-75-1/urapidil; 50-60-2/Phentolamine |
| Comments/Corrections | |
Comment In:
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Circulation. 1999 Feb 2;99(4):468-71
[PMID:
9927390
]
Circulation. 2000 Feb 29;101(8):E87-8 [PMID: 10694538 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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