Document Detail

Endothelium-dependent dilation of the coronary microvasculature is impaired in dilated cardiomyopathy.
MedLine Citation:
PMID:  2306829     Owner:  NLM     Status:  MEDLINE    
Dilator reserve of the coronary microvasculature is diminished in patients with dilated cardiomyopathy. Although increased extravascular compressive forces, tachycardia, and increased myocardial mass can explain some impairment, recent evidence suggests the possibility of intrinsic microvascular disease. We tested the hypothesis that impairment of endothelium-dependent dilation of the microvasculature could be a contributing mechanism. We infused the endothelium-dependent dilator acetylcholine (Ach) (10(-8) to 10(-6) M) and the smooth muscle vasodilator adenosine (AD) (10(-6) to 10(-4) M) into the left anterior descending coronary artery in eight patients with dilated cardiomyopathy (mean ejection fraction, 28%) and seven controls (atypical chest pain). Small vessel resistance was assessed by measuring coronary blood flow (CBF) at constant arterial pressure with a Doppler velocity catheter (corrected for cross-sectional area by angiography). With Ach, control patients increased CBF 232 +/- 40% (mean +/- SEM), whereas CBF did not significantly change in cardiomyopathy patients (41 +/- 24%) (p less than 0.0001, control vs. cardiomyopathy). With AD, control patients increased CBF 422 +/- 56% and cardiomyopathy patients increased CBF 268 +/- 43% (p = 0.13). An index of the proportion of coronary flow reserve attributable to endothelium-dependent vasodilation was obtained by standardizing each patient's Ach dose response to his maximal AD flow response. In seven control patients receiving both Ach and AD, 56 +/- 9% of the maximal AD flow response was attained with the endothelium-dependent vasodilator Ach, whereas in seven cardiomyopathy patients receiving both Ach and AD, only 23 +/- 14% of the maximal AD response was attained (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
C B Treasure; J A Vita; D A Cox; R D Fish; J B Gordon; G H Mudge; W S Colucci; M G Sutton; A P Selwyn; R W Alexander
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  81     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1990 Mar 
Date Detail:
Created Date:  1990-04-05     Completed Date:  1990-04-05     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  772-9     Citation Subset:  AIM; IM    
Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Boston, MA 02115.
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MeSH Terms
Acetylcholine / diagnostic use
Adenosine / diagnostic use
Cardiomyopathy, Dilated / physiopathology*
Coronary Circulation / physiology*
Coronary Vessels / physiopathology*
Endothelium, Vascular / physiology*
Microcirculation / physiopathology
Middle Aged
Nitric Oxide / physiology
Vascular Resistance / physiology
Vasodilation / drug effects,  physiology*
Grant Support
Reg. No./Substance:
10102-43-9/Nitric Oxide; 51-84-3/Acetylcholine; 58-61-7/Adenosine

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