Response of the left anterior descending coronary artery to acetylcholine in patients with chest pain and angiographically normal coronary arteries.
Because atherosclerotic plaque burden affects the likelihood of plaque rupture, it is important to determine the presence and extent of atherosclerotic plaque. We hypothesized that endothelial dysfunction becomes more prominent with development of atherosclerotic plaque; therefore, we examined the relation between coronary endothelial dysfunction and the presence of atherosclerotic plaque. In 36 patients with normal coronary arteries, acetylcholine (ACh; 3 and 30 microg/min) and nitroglycerin were infused into the left coronary ostium, and the diameter of the left anterior descending (LAD) coronary artery was quantitatively measured in response to each drug. The plaque burden was measured in the same segment using intravascular ultrasonography. The plaque burden was 31.2 +/- 2.1% and correlated inversely with changes in coronary diameter induced by 3 microg/min of ACh (r = -0.754, p <0.0001), 30 microg/min of ACh (r = -0.552, p = 0.0005), and nitroglycerin (r = -0.531, p = 0.0009). Multivariate regression analysis showed that the change in coronary diameter induced by 3 microg/min of ACh was associated with plaque burden, independent of the effects of nitroglycerin-induced dilation. Receiver-operating characteristics analysis demonstrated that a cut-off value for the change in coronary diameter induced by 3 microg/min of ACh for predicting a plaque burden of >30% was 0%, with a sensitivity of 0.82 and a specificity of 0.95. These findings suggest that coronary endothelial dysfunction is correlated with atherosclerotic plaque burden, indicating that atherosclerotic plaque may be detected based on coronary endothelial function as assessed by low-dose ACh infusion.
Matsuda
Keiji
K
Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Teragawa
Hiroki
H
Fukuda
Yukihiro
Y
Ueda
Kentaro
K
Higashi
Yukihito
Y
Sakai
Kenya
K
Miura
Fumiharu
F
Hirao
Hidekazu
H
Yamagata
Togo
T
Yoshizumi
Masao
M
Chayama
Kazuaki
K
D000109:Acetylcholine; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D002637:Chest Pain / Q000000981:diagnostic imaging; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects*; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005996:Nitroglycerin; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents
D008078:Cholesterol, LDL; D014665:Vasodilator Agents; D005996:Nitroglycerin; D000109:Acetylcholine