Author + information
- Received April 23, 1990
- Revision received July 3, 1990
- Accepted July 19, 1990
- Published online January 1, 1991.
- Eric J. Eichhorn, MD, FACC∗,
- Paul A. Grayburn, MD, FACC,
- John E. Willard, MD,
- H.Vernon Anderson, MD,
- John B. Bedotto, MD,
- Melissa Carry, MD,
- Joel K. Kahn, MD and
- James T. Willerson, MD, FACC
- ↵∗Address for reprints: Eric J. Eichhorn, MD, Division of Cardiology (111A2), University of Texas Southwestern and Dallas Veterans Administration Medical Centers, 4500 South Lancaster, Dallas, Texas 75216.
Cyclic coronary artery flow variations with a spontaneous decline in coronary blood flow to very low levels have been documented in stenosed canine coronary arteries with endothelial injury. These flow variations are associated with transient platelet aggregation and dislodgment and the release of selected mediators, including thromboxane A2and serotonin. However, cyclic or spontaneous How variations have not been demonstrated in stenosed coronary arteries in humans.
In this study, the hypothesis was tested that spontaneous coronary blood flow velocity variations occur in some patients with stenosed coronary arteries before or after coronary artery angioplasty. Thus, 13 patients with severe and limiting angina underwent intracoronary pulsed Doppler velocimetry of their dilated artery immediately before and after percutaneous transluminal coronary angioplasty, whereas 9 control patients underwent velocimetry of an angiographically normal coronary artery. A 3F catheter with a 20 MHz Doppler crystal was positioned to achieve a maximal stable signal, and the flow velocity signal was recorded continuously for 20 min.
Spontaneous flow velocity variations (≥38% change in Doppler frequency shift with wide morphologic changes) were present in 3 of the 13 patients tested. Spontaneous flow velocity variations occurred before angioplasty in one patient, after angioplasty in another and both before and after angioplasty in a third. In addition, 2 of the 13 patients, 1 with spontaneous coronary artery flow velocity variations before angioplasty, had frank vasospasm in an adjacent area just distal to the area of coronary dilation immediately after balloon inflation.
These data establish that spontaneous coronary artery flow velocity variations occur in some patients with severe and limiting angina before and after coronary angioplasty. These variations may be related to platelet aggregation or coronary vasoconstriction, or both, at sites of endothelial injury resulting from plaque fissuring or ulceration and endothelial and medial injury occurring during coronary angioplasty.
☆ This study was supported in part by the NHLBI Ischemic SCOR Grant HL-17669 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and the David Bruton Jr. Charitable Trust, Moss Heart Fund and Merit Review Grant from the Veterans Administration, Dallas, Texas. It was presented at the 62nd Annual Scientific Session of the American Heart Association, New Orleans, Louisiana, November 1989.
- Received April 23, 1990.
- Revision received July 3, 1990.
- Accepted July 19, 1990.