Vrints C J, Bult H, Hitter E, Herman A G, Snoeck J P
Department of Cardiology, University Hospital, Antwerp, Belgium.
J Am Coll Cardiol. 1992 Jan;19(1):21-31. doi: 10.1016/0735-1097(92)90046-p.
The coronary vasomotor responses to selective infusion of graded concentrations (10(-6) to 10(-4) M) of acetylcholine into the left anterior descending artery were assessed by quantitative coronary arteriography in 24 patients with normal coronary arteriograms (12 patients with atypical symptoms and 12 patients with typical anginal pain) and 36 patients with coronary artery disease with different degrees of atherosclerosis of the left anterior descending artery. In the patients with normal coronary arteries and atypical chest pain, acetylcholine induced predominantly a vasodilator response, which was maximal during a 10(-5) M acetylcholine infusion. In contrast, in patients with coronary artery disease, acetylcholine caused dose-dependent vasoconstriction, which was observed even if the left anterior descending artery itself was smooth. Marked vasoconstriction was also induced in the patients with typical anginal pain and angiographically normal coronary arteries. In nine of these patients, this constrictor response was associated with anginal pain and electrocardiographic evidence of myocardial ischemia. Intracoronary administration of isosorbide dinitrate (1 mg) relieved the anginal pain and dilated all vessels. These data suggest that 1) patients with normal coronary arteriograms and angina pectoris manifest impairment of endothelium-dependent vasodilation similar to that observed in patients with overt coronary atherosclerosis; and 2) abnormal coronary vasoconstrictor responses resulting from this impairment may contribute to the pathogenesis of myocardial ischemia and angina in these patients.
通过定量冠状动脉造影术，评估了24例冠状动脉造影正常的患者（12例有非典型症状，12例有典型心绞痛）以及36例左前降支动脉有不同程度动脉粥样硬化的冠心病患者，对向左前降支动脉选择性输注梯度浓度（10⁻⁶至10⁻⁴M）乙酰胆碱的冠状动脉血管舒缩反应。在冠状动脉正常且有非典型胸痛的患者中，乙酰胆碱主要引起血管舒张反应，在输注10⁻⁵M乙酰胆碱时反应最大。相反，在冠心病患者中，乙酰胆碱引起剂量依赖性血管收缩，即使左前降支动脉本身是光滑的也会出现这种情况。有典型心绞痛且冠状动脉造影正常的患者也会出现明显的血管收缩。在其中9例患者中，这种收缩反应与心绞痛和心肌缺血的心电图证据相关。冠状动脉内给予硝酸异山梨酯（1mg）可缓解心绞痛并使所有血管扩张。这些数据表明：1）冠状动脉造影正常且有心绞痛的患者表现出内皮依赖性血管舒张功能受损，类似于在明显冠状动脉粥样硬化患者中观察到的情况；2）这种损伤导致的异常冠状动脉血管收缩反应可能促成这些患者心肌缺血和心绞痛的发病机制。
