title: Effect of percutaneous transluminal coronary angioplasty on circulating endothelin levels.
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.
authors.affiliation: Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California 90048.
authors.forename: S
authors.initials: S
authors.lastname: Ameli
authors.forename: S
authors.initials: S
authors.lastname: Kaul
authors.forename: L
authors.initials: L
authors.lastname: Castro
authors.forename: C
authors.initials: C
authors.lastname: Arora
authors.forename: A
authors.initials: A
authors.lastname: Mirea
authors.forename: P K
authors.initials: PK
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D009320:Atrial Natriuretic Factor / Q000097:blood; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000097:blood* / Q000628:therapy; D016232:Endothelins / Q000097:blood*; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood
chemical_list: D016232:Endothelins; D009320:Atrial Natriuretic Factor; D009638:Norepinephrine; D004837:Epinephrine