Document Detail

Effects of naloxone on myocardial ischemic preconditioning in humans.
MedLine Citation:
PMID:  10362186     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We attempted to establish whether naloxone, an opioid receptor antagonist, abolishes the adaptation to ischemia observed in humans during coronary angioplasty after repeated balloon inflations. BACKGROUND: Experimental studies indicate that myocardial opioid receptors are involved in ischemic preconditioning. METHODS: Twenty patients undergoing angioplasty for an isolated stenosis of a major epicardial coronary artery were randomized to receive intravenous infusion of naloxone or placebo during the procedure. Intracoronary electrocardiogram and cardiac pain (using a 100-mm visual analog scale) 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 the six patients of each group with a stenosis on the left anterior descending coronary artery. RESULTS: In naloxone-treated patients, ST-segment changes and cardiac pain severity during the second inflation were similar to those observed during the first inflation (12+/-6 vs. 11+/-7 mm, p = 0.3, and 58+/-13 vs. 56+/-12 mm, p = 0.3, respectively), whereas in placebo-treated patients, they were significantly less (6+/-3 vs. 13+/-6 mm, p = 0.002 and 31+/-21 vs. 55+/-22 mm, p = 0.008, respectively). In both naloxone- and placebo-treated patients, average peak velocity significantly increased from baseline to the end of the first inflation (p = 0.04 and p = 0.02, respectively), but it did not show any further increase during the second inflation. CONCLUSIONS: The adaptation to ischemia observed in humans after two sequential coronary balloon inflations is abolished by naloxone and is independent of collateral recruitment. Thus, it is due to ischemic preconditioning and is, at least partially, mediated by opioid receptors, suggesting their presence in the human heart.
F Tomai; F Crea; A Gaspardone; F Versaci; A S Ghini; C Ferri; G Desideri; L Chiariello; P A Gioffré
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  33     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-06-22     Completed Date:  1999-06-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1863-9     Citation Subset:  AIM; IM    
Divisione di Cardiochirurgia, Università di Roma Tor Vergata, European Hospital, Rome, Italy.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary
Blood Flow Velocity / drug effects
Chest Pain / diagnosis,  therapy
Collateral Circulation / drug effects
Coronary Vessels / ultrasonography
Electrocardiography / methods
Follow-Up Studies
Ischemic Preconditioning, Myocardial* / methods
Middle Aged
Myocardial Ischemia / metabolism,  physiopathology,  therapy*
Naloxone / pharmacology*
Narcotic Antagonists / pharmacology*
Pain Measurement
Receptors, Opioid / antagonists & inhibitors
Single-Blind Method
Treatment Outcome
Ultrasonography, Interventional
Reg. No./Substance:
0/Narcotic Antagonists; 0/Receptors, Opioid; 465-65-6/Naloxone

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