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Can atherosclerotic coronary arteries vasodilate? An intraoperative high-frequency epicardial echocardiographic study
D D McPherson1, S Sirna, S M Collins
1Department of Medicine, University of Iowa, Iowa City, USA.
Insights
This study used high-frequency echocardiography to assess nitroglycerin's effect on atherosclerotic coronary arteries. Nitroglycerin improved vasodilating responses in these arteries, indicating potential therapeutic benefits.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Pharmacology
Background:
- Atherosclerosis impairs coronary artery vasodilation.
- Intraoperative assessment of coronary artery function is crucial.
Purpose of the Study:
- To evaluate vasodilating responses in atherosclerotic coronary arteries using intraoperative high-frequency epicardial echocardiography.
- To assess the impact of nitroglycerin on lumen area and shape in these arteries.
Main Methods:
- High-frequency (12 MHz) epicardial echocardiography was used for continuous recordings during surgery.
- Cross-sectional lumen area was determined for 17 coronary arterial segments in 12 patients.
- Arterial images were classified by lumen area, atherosclerotic wall thickness, and lumen shape (concentric vs. eccentric).
Main Results:
- Nitroglycerin administration (100-400 µg/min) reduced mean arterial pressure by 14 mmHg.
- Segments with small lumens (<5.0 mm²) showed a mean luminal area increase of 0.8 mm² (39%).
- Segments with larger lumens (>5.0 mm²) demonstrated a mean luminal area increase of 4.3 mm² (51%).
- Eccentric lumens showed a 39% area increase, while concentric lumens increased by 48% with nitroglycerin (p=NS).
Conclusions:
- High-frequency epicardial echocardiography effectively evaluates vasodilating responses in atherosclerotic coronary arteries.
- Nitroglycerin demonstrates vasodilatory effects in atherosclerotic coronary arteries, regardless of lumen shape.
- These findings support the use of nitroglycerin for managing coronary artery dysfunction in atherosclerosis.
Abstract:
Our purpose was to evaluate the vasodilating responses of atherosclerotic coronary arteries using intraoperative high-frequency (12 MHz) epicardial echocardiography. We obtained continuous high-frequency epicardial echocardiographic recordings during surgery, and determined cross-sectional lumen area from 17 coronary arterial segments (12 patients). Nitroglycerin (100 to 400 micrograms/min) was administered intravenously to reduce mean (+/- SEM) arterial pressure 14 +/- 1.8 mm Hg. The cross-sectional arterial images were classified using 3 different parameters: arterial lumen area, percentage of the arterial wall circumference that was atherosclerotic (wall thickness > 0.7 mm), and presence of an eccentrically shaped arterial lumen (maximal/minimal luminal diameter > 1.5). Nine arterial segments had small (< 5.0 mm2) arterial lumens (1.7 +/- 0.40 mm2 [+/- SEM; range 0.6 to 3.9]). With nitroglycerin, the luminal area increased 0.8 +/- 0.28 mm2 (range 0 to 2.5), and 39 +/- 12.1% (range 0 to 117). The remaining 8 segments had larger (> 5.0 mm2) lumens (8.7 +/- 0.91 mm2 [range 5.0 to 11.9]). With nitroglycerin the luminal area increased 4.3 +/- 1.11 mm2 (range 1.4 to 11.4), and 51 +/- 10.2% (range 16 to 96). Seven arterial segments had eccentric lumens; mean maximal/minimal ratio was 1.8 +/- 0.08 (range 1.6 to 2.0). The area increased 39 +/- 7.3% (range 16 to 71) with nitroglycerin. In the 10 concentrically shaped lumens (maximal/minimal lumen diameters 1.3 +/- 0.04 [range 1.1 to 1.5]), nitroglycerin increased luminal area by 48 +/- 12.6% (range 0 to 117) (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
