Related Experiment Videos
Effect of percutaneous transluminal coronary angioplasty on circulating endothelin levels
1Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California 90048.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) increases circulating endothelin, a vasoconstrictor peptide, and atrial natriuretic factor. This study suggests endothelial injury during PTCA influences these vasoactive mediators and coronary vascular tone.
Area of Science:
- Cardiovascular Physiology
- Endocrinology
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) can cause vasoconstriction.
- Mechanisms underlying PTCA-induced vasoconstriction are not fully understood.
- Endothelial disruption is a potential factor influencing vascular tone post-PTCA.
Purpose of the Study:
- To investigate the hypothesis that endothelial disruption during PTCA increases circulating endothelin levels.
- To examine the association between PTCA, endothelin, and other vasoactive mediators.
- To explore the impact of these humoral changes on coronary vascular tone.
Main Methods:
- Measured circulating levels of endothelin, atrial natriuretic factor, epinephrine, and norepinephrine.
- Samples were collected immediately before and after PTCA in 23 coronary artery disease patients.
- Angiography alone served as a control for the effect of PTCA procedure.
Main Results:
- Endothelin levels significantly increased post-PTCA (p < 0.005), but not after angiography alone.
- Atrial natriuretic factor levels also significantly increased post-PTCA (p = 0.01).
- Epinephrine and norepinephrine levels significantly decreased post-PTCA (p = 0.005 and p = 0.003, respectively).
Conclusions:
- Endothelial injury during PTCA is associated with elevated circulating endothelin.
- Increased endothelin is accompanied by elevated atrial natriuretic factor and decreased catecholamines.
- These humoral changes likely modulate coronary vascular tone following PTCA.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) is frequently associated with vasoconstriction involving large vessels as well as microcirculation, but the potential mechanisms remain poorly defined. In this study, we tested the hypothesis that endothelial disruption during PTCA is associated with an increase in circulating levels of endothelin, a potent endothelium-derived vasoconstrictor peptide. Circulating levels of endothelin and other potential vasoactive mediators such as atrial natriuretic factor, epinephrine and norepinephrine were measured immediately before and after PTCA in 23 patients with coronary artery disease. Although there was no change in the endothelin levels after angiography alone (43 +/- 5 vs 44 +/- 7 pg/ml, p = 0.5), there was a significant increase after PTCA (32 +/- 8 to 37 +/- 10 pg/ml, p < 0.005). The increase in endothelin was associated with a significant increase in atrial natriuretic factor (78 +/- 57 to 129 +/- 131 ng/ml, p = 0.01) and a decrease in epinephrine and norepinephrine levels (111 +/- 64 to 59 +/- 36 pg/ml, p = 0.005, and 1,131 +/- 500 to 811 +/- 311 pg/ml, p = 0.003, respectively). Circulating levels of endothelin did not correlate with the percent coronary stenosis before or after PTCA or the presence or absence of angiographically visible thrombus. These findings suggest that endothelial injury during PTCA may be associated with increased circulating levels of endothelin and its counter-regulatory hormone, atrial natriuretic factor, and also with a reciprocal decrease in epinephrine and norepinephrine levels. Thus, these humoral changes may modulate changes in coronary vascular tone after PTCA.