Document Detail


Endothelium dependent and independent responses in coronary artery disease measured at angioplasty.
MedLine Citation:
PMID:  7518687     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE--To investigate the effects of substance P and papaverine, two drugs that increase coronary blood flow by different mechanisms, on vasomotion in stenotic coronary arteries at percutaneous transluminal coronary angioplasty (PTCA). DESIGN--Coronary blood flow responses to substance P and papaverine were measured in stenotic coronary arteries at the time of PTCA with quantitative angiography and a Doppler flow probe. SETTING--A cardiothoracic referral centre. PATIENTS--15 patients undergoing elective PTCA of a discrete epicardial coronary artery stenosis. INTERVENTIONS--Pharmacological coronary flow reserve was determined with papaverine 5-10 minutes before and after successful PTCA. Endothelium dependent responses to 2 minute infusions of substance P (10-15 pmol.min-1) were assessed immediately before PTCA. MAIN OUTCOME MEASURES--Coronary blood flow responses and changes in epicardial coronary artery area at stenotic, proximal, and distal sites with papaverine and substance P. RESULTS--Stenotic sites dilated with papaverine before PTCA (17.7%(6.9%) (mean (SEM)) area increase, p < 0.05 v baseline). Substance P dilated stenotic sites (16.8%(5.7%) area increase, p < 0.05) and proximal (14.3%(5.4%), p < 0.05) and distal sites (41.7%(9.3%), p < 0.005). Coronary flow reserve increased but did not reach normal values after PTCA (2.3(0.4) before PTCA v 3.0(0.4) after PTCA, p < 0.05) and was associated with an increase in peak flow with papaverine. Angioplasty did not alter baseline flow. After PTCA papaverine caused significant vasoconstriction at the stenotic site (-13.6%(4.3%) area decrease, p < 0.05). There was a negative correlation (r = -0.68, p < 0.05) between the dilator response with papaverine before PTCA and the constrictor response after PTCA. CONCLUSIONS--Substance P causes endothelium dependent dilatation in atheromatous coronary arteries, even at sites of overt atheroma. The cause of the paradoxical constrictor response to papaverine after PTCA is uncertain, but unopposed flow mediated vasoconstriction (the myogenic response) after balloon induced endothelial denudation may be one of several contributory factors.
Authors:
D R Holdright; D Clarke; P A Poole-Wilson; K Fox; P Collins
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  British heart journal     Volume:  70     ISSN:  0007-0769     ISO Abbreviation:  Br Heart J     Publication Date:  1993 Jul 
Date Detail:
Created Date:  1994-08-25     Completed Date:  1994-08-25     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0370634     Medline TA:  Br Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  35-42     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiac Medicine, National Heart and Lung Institute, London.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Angiography
Coronary Artery Disease / physiopathology,  therapy*
Coronary Circulation / drug effects*
Endothelium, Vascular / drug effects*,  physiology
Female
Humans
Male
Middle Aged
Papaverine / pharmacology*
Substance P / pharmacology*
Vasodilation / drug effects,  physiology
Chemical
Reg. No./Substance:
33507-63-0/Substance P; 58-74-2/Papaverine
Comments/Corrections

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