Author + information
- Received May 10, 1994
- Revision received December 2, 1994
- Accepted December 8, 1994
- Published online April 1, 1995.
- William F. Penny, MD, FACCa,b,
- Howard Rockman, MD, FACCa,b,
- John Long, PhDa,b,
- Valmik Bhargava, PhD, FACCa,b,
- Ken Carrigan, BSa,b,
- Alaa Ibriham, MDa,b,
- Ralph Shabetai, MD, FACCa,b,
- John Ross Jr., MD, FACCa,b and
- Kirk L. Peterson, MD, FACCa,b,*
- ↵*Address for correspondence: Dr. Kirk L. Peterson, c/o UCSD Medical Center-8411, 200 West Arbor Drive, San Diego, California 92103.
Objectives. In view of the segmental occurrence of coronary atherosclerosis, we postulated that acetylcholine may cause heterogeneous vasomotion, depending on the extent of vessel analyzed, criteria for change in vessel caliber and dose of drug administered.
Background. Previous studies have reported that acetylcholine causes constriction of atherosclerotic arteries. This dysfunction of endothelium-dependent dilation may be seen without angiographically detectable disease.
Methods. We developed algorithms to quantitate the dimensions of a single coronary artery over virtually its entire length during a control state and during graded doses of intracoronary acetylcholine. On the basis of triplicate control angiograms, the limit of detection of a change from control diameter was 0.31 mm (≥2 SD).
Results. Analysis of multiple segments (each 5.6 ± 1.1 [mean ±SD]mm) along a single coronary artery revealed a heterogeneous response to acetylcholine in 27 of 31 patients at the 10−4mol/liter dose and in 29 of 31 patients when responses at 10−6, 10−5and 10−4mol/liter doses were combined; in this latter analysis, constriction and dilation in the same vessel occurred in 45% of the patients. With acetylcholine, most of 349 segments demonstrated no change, but the greatest frequency of vasoconstriction (24.6%) and vasodilation (6.9%) was seen at the 10−4mol/liter dose. Inducible vasomotion was observed as far distally as 7.3 cm from the site of acetylcholine infusion.
Conclusions. Response to intracoronary acetylcholine with mild coronary disease is heterogeneous; disparate dimensional responses may occur in different segments of the same vessel. Inclusion of all analyzable regions of a coronary artery and the use of a reproducibility limit for quantitative angiography are optimal for assessment of segmental coronary vasomotion.
This study was supported in part by Ischemic Specialized Center of Research Grant, HL-18682-19 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; the San Diego Foundation for Cardiovascular Research and Education, San Diego, California; and a research grant from Merck & Co., Inc., West Point, Pennsylvania.
- Received May 10, 1994.
- Revision received December 2, 1994.
- Accepted December 8, 1994.
- North American Society of Pacing and Electrophysiology; American College of Cardiology; American Heart Association, Inc.; and European Society of Cardiology.