Morgagni Gl

Endothelial Function Predicts Future Development of Coronary Artery Disease A Study of Women With Chest Pain and Normal Coronary Angiograms

Background—The prognosis for women with chest pain and angiographically normal coronary arteries is believed to be totally benign. Previous studies, however, did not account for the delay of a decade or so in the development of coronary artery disease that women may experience. Methods and Results—This study assessed long-term follow-up of 42 women with de novo angina, evidence of reversible myocardial perfusion defects on SPECT, and normal coronary angiograms. At recruitment, all women underwent endothelial function testing (intracoronary acetylcholine) during catheterization. Patients were followed up for >10 years. Angiography was repeated at the end of the follow-up in 37 patients. At recruitment, 22 patients developed diffuse vasoconstriction during acetylcholine in the absence of identifiable focal coronary spasm (acetylcholine-positive group). The remaining 20 patients showed vasodilation (acetylcholine-negative group). At the end of follow-up, in the acetylcholine-positive group, 1 patient developed cardiac death, 13 still complained of chest pain, and 8 had remission of symptoms. In the acetylcholine-negative group, all patients showed complete resolution of chest pain beginning 6 to 36 months after baseline assessment. Angiography showed development of coronary artery disease in the 13 symptomatic patients in the acetylcholine-positive group. Conclusions—In women with angiographically normal-appearing coronary arteries, persistence of chest pain over the years often relates to development of coronary artery disease. Endothelial dysfunction in a setting of normal coronary arteries is a sign of future development of atherosclerosis.

Effect of oral levodopa and carbidopa on coronary spasm in variant angina pectoris

The effect of oral administration of 500 mg of levodopa with 50 mg of carbidopa, a peripheral dopadecarboxylase inhibitor, on coronary vasomotion during vasoconstrictor stimuli was examined in 15 patients with variant angina presenting with hyperventilation-induced myocardial ischemia. Patients were studied during 3 noninvasive sessions and 1 angiographic session. In all sessions the basic protocol consisted of provocation of coronary spasm by hyperventilation before and 2 hours after levodopa and carbidopa administration. During angiography, great cardiac vein blood flow, right atrial and aortic pressures were measured, and coronary angiograms were recorded at baseline and 1 to 4 minutes after each hyperventilation. Samples for dopamine plasma levels were drawn before and throughout the studies. In 3 selected patients, levodopa and carbidopa were associated with 30 mg of domperidone, an antagonist of dopamine peripheral receptors. Levodopa and carbidopa consistently prevented the occurrence of ischemia after hyperventilation in 6 of the 15 patients. This was due to inhibition of local coronary spasm in 2 patients and reduced coronary constriction in 4. Ischemia due to hyperventilation was still prevented despite addition of domperidone with levodopa and carbidopa. Plasma dopamine levels were 23 +/- 15 before and 739 +/- 284 pg/ml 2 hours after administration of levodopa and carbidopa. These findings are consistent with either a decreased central dopaminergic activity and associated disregulation of vasomotor tone, or a peripheral vasodilatory effect of increasing dopamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Invasive monitoring of coronary blood flow in acute myocardial infarction: pathogenetic and therapeutic relevance

The need to develop a reliable marker of reperfusion is important in view of the large number of pts in whom thrombolysis is now likely to be used. We measured coronary blood flow (CBF; thermodilution technique) in 12 pts presenting with acute myocardial infarction (AMI) and ST elevation in the anterior leads. After application of i.v. thrombolytic therapy (urokinase, 2 mil IU), CBF was measured every 30 min for 4 hrs and then every 4 hrs for 20 hrs. Coronary blood flow increased by more than 30% in 9 pts (G1): from 86±24 to 126±46 ml/min; p < 0.001. No significant changes were seen in the remaining 3 pts (G2). Coronary angiography was performed in all pts and showed patency of the infarct-related artery in 8/9 G1 pts (89%) and occlusion in the remaining four pts. We conclude that measurement of CBF is a relatively simple technique that appears both sensitive and specific in detecting coronary reperfusion in anterior AMI.