title: Sympathetic stimulation using the cold pressor test increases coronary collateral flow.
abstract: BACKGROUND
  Little is known about the vasomotor function of human coronary collateral vessels. The purpose of this study was to examine collateral flow under a strong sympathetic stimulus (cold pressor test, CPT).
  
  
  METHODS
  In 30 patients (62 +/- 12 years) with coronary artery disease, two subsequent coronary artery occlusions were performed with random CPT during one of them. Two minutes before and during the 1 minute-occlusion, the patient's hand was immerged in ice water. For the calculation of a perfusion pressure-independent collateral flow index (CFI), the aortic (Pao), the central venous (CVP) and the coronary wedge pressure (Poccl) were measured: CFI = (Poccl - CVP)/(Pao - CVP).
  
  
  RESULTS
  CPT lead to an increase in Pao from 98 +/- 14 to 105 +/- 15 mm Hg (p = 0.002). Without and with CPT, CFI increased during occlusion from 14% +/- 10% to 16% +/- 10% (p = 0.03) and from 17% +/- 9% to 19% +/- 9% (p = 0.006), respectively, relative to normal flow. During CPT, CFI was significantly higher at the beginning as well as at the end of the occlusion compared to identical instants without CPT. CFI at the end of the control occlusion did not differ significantly from the CFI at the beginning of occlusion with CPT.
  
  
  CONCLUSIONS
  During balloon occlusion, collateral flow increased due to collateral recruitment independent of external sympathetic stimulation. Sympathetic stimulation using CPT additionally augmented collateral flow. The collateral-flow-increasing effect of CPT is comparable to the recruitment effect of the occlusion itself. This may reflect a coronary collateral vasodilation mediated by the sympathetic nervous system.
authors.affiliation: Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: S F
authors.initials: SF
authors.lastname: de Marchi
authors.forename: M
authors.initials: M
authors.lastname: Schwerzmann
authors.forename: M
authors.initials: M
authors.lastname: Billinger
authors.forename: S
authors.initials: S
authors.lastname: Windecker
authors.forename: B
authors.initials: B
authors.lastname: Meier
authors.forename: C
authors.initials: C
authors.lastname: Seiler
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001011:Aorta / Q000503:physiopathology; D021721:Balloon Occlusion; D002496:Central Venous Pressure / Q000502:physiology; D003080:Cold Temperature; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D003326:Coronary Circulation / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010812:Physical Stimulation; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014664:Vasodilation / Q000502:physiology*