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Reactivity of proximal and distal angiographically normal and stenotic coronary segments in chronic stable angina
D Tousoulis1, J C Kaski, P Bogaty
1Cardiovascular Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
Insights
Coronary artery vasoreactivity differs by location; distal segments show greater dilation with nitrates and constriction with ergonovine compared to proximal segments. This impacts assessment of coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) affects millions globally, necessitating accurate diagnostic tools.
- Understanding coronary vasoreactivity is crucial for assessing stenosis severity and guiding treatment.
- Proximal and distal coronary segments may exhibit differential responses to vasoactive agents.
Purpose of the Study:
- To investigate if vasoreactivity of significant coronary stenosis and normal coronary segments differs between proximal and distal locations.
- To compare the effects of nitrates and ergonovine on coronary segment diameter in different locations.
Main Methods:
- 53 patients with stable angina and CAD underwent coronary arteriography.
- Quantitative angiography assessed intraluminal diameter changes before and after intracoronary isosorbide dinitrate and ergonovine.
- 126 normal and 43 stenotic coronary segments (proximal and distal) were analyzed.
Main Results:
- Nitrates significantly dilated both normal and stenotic segments, with greater dilation observed in distal segments compared to proximal ones.
- Ergonovine significantly constricted normal segments, again showing a more pronounced effect in distal locations.
- Significant proximal stenoses dilated more than proximal normal segments after nitrates, and distal stenoses dilated more than distal normal segments.
Conclusions:
- Coronary vasoreactivity varies significantly between proximal and distal segments.
- Distal coronary segments demonstrate greater responsiveness to both vasodilatory (nitrates) and constrictive (ergonovine) stimuli.
- These location-dependent differences in vasoreactivity are important considerations in the angiographic assessment of coronary artery disease.
Abstract:
To assess whether vasoreactivity of significant coronary stenosis (greater than 50% intraluminal diameter reduction) and that of angiographically normal coronary segments differs in proximal and distal locations, 53 patients (40 men, 13 women, mean +/- standard deviation age 55 +/- 11 years) with chronic stable angina and angiographically documented coronary artery disease were studied. While abstaining from antianginal therapy, all 53 patients underwent coronary arteriography before and after 1 mg of intracoronary isosorbide dinitrate and 21 of the 53 also before and after 20 to 30 micrograms intracoronary ergonovine. Computerized quantitative angiography was used to assess changes in the intraluminal diameter of 126 normal coronary segments (63 proximal, 63 distal) and 43 significant coronary stenoses. Nitrates dilated proximal normal coronary segments by 7.4 +/- 1.2% and distal normal coronary segments by 15 +/- 1.7% (p less than 0.01). Significant proximal coronary stenoses dilated by 11 +/- 2.5% and distal stenoses by 23 +/- 2.8% (p less than 0.01) after nitrates. Ergonovine reduced the diameter of proximal normal coronary segments by 9.3 +/- 1.7% and that of normal distal segments by 15.5 +/- 1.4% (p less than 0.01). Proximal stenoses constricted by 11 +/- 2.2% and distal stenoses by 18.4 +/- 2.8% (p = 0.06). Analysis of segments showed that nitrates dilated 19 of 63 (30%) proximal normal segments by (greater than or equal to 10%), 31 of 63 (49%) distal (p less than 0.05) and 21 of 43 (49%) stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)