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A double-blind, randomized study of the effect of immediate intravenous nitroglycerin on the incidence of postprocedural chest pain and minor myocardial necrosis after elective coronary stenting

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AMERICAN HEART JOURNAL 2000年第1期139卷 35-43页

作者： Kurz, DJ Naegeli, B Bertel, O Triemli Hosp Dept Internal Med Div Cardiol CH-8063 Zurich Switzerland

Background Anginal chest pain without creatine kinase (CK) elevation is frequently observed in the first hours after coronary stenting. Possible causes of ischemic episodes are microembolism, side branch occlusion, coronary vasospasm, and disturbances of microvascular circulation. In a prospective, double-blind, randomized trial, we tested the effect of intravenous nitroglycerin on the incidence of angina and minor myocardial necrosis (MMN), as detected by cardiac troponin I increase, after elective coronary stenting. Methods and Results One hundred patients were randomly assigned to intravenous nitroglycerin (group A: n = 50, goal dose 100 mu g/min) or placebo (group B: n = 50, NaCl 0.9%) during 12 hours after stenting. Patients with acute myocardial infarction, known intolerance to nitrates, and hemodynamic instability during angioplasty were excluded. The 2 groups were comparable in respect to baseline and interventional variables, except for age (group A: 60 +/- 9 years, group B: 56 +/- 10 years;P = .04). The incidence of chest pain was not influenced by nitroglycerin (group A: 18%, group B: 22%;P = not significant). However, the occurrence of MMN was significantly reduced by nitroglycerin (group A: 5%, group B: 19%, P = .036). A rise in CK with significant CK-MB fraction was observed in only 2 patients in group B (both less than twice upper limit). Only 4 of the 10 patients with MMN also had chest pain. Conclusions Routine use of intravenous nitroglycerin after coronary stenting significantly reduced the occurrence of minor myocardial necrosis. However, the incidence of postprocedural chest pain remained unchanged.

关键词：心绞痛/血液心绞痛/预防和控制心绞痛/放射摄影术血管成形术经腔经皮冠状动脉生物学标记/血液冠状血管造影术冠心病/放射摄影术冠心病/治疗双盲法移植物闭塞血管/并发症移植物闭塞血管/药物疗法移植物闭塞血管/放射摄影术心脏/药物作用发病率注射静脉内心肌梗死/药物疗法心肌梗死/病因学心肌梗死/放射摄影术心肌/病理学坏死硝酸甘油/投药和剂量疼痛手术后/血液疼痛手术后/预防和控制疼痛手术后/放射摄影术前瞻性研究支架肌钙蛋白I/血液血管舒张药/投药和剂量女(雌)性人类男(雄)性中年人

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Gender differences in sensitivity to adrenergic agonists of forearm resistance vasculature

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第4期36卷 1233-1238页

作者： Kneale, BJ Chowienczyk, PJ Brett, SE Coltart, DJ Ritter, JM Kings Coll London Ctr Cardiovasc Biol & Med Dept Clin Pharmacol London WC2R 2LS England Kings Coll London Ctr Cardiovasc Biol & Med Dept Cardiol London WC2R 2LS England

OBJECTIVES The goal of this study was to investigate the mechanism of reduced vasoconstrictor sensitivity to norepinephrine in women compared with men. BACKGROUND beta(2)-adrenergic agonists such as albuterol dilate forearm resistance vessels, partly by activating the alpha-arginine/nitric oxide pathway. Norepinephrine (which acts as beta- as well. as alpha-adrenergic receptors) causes less forearm vasoconstriction in women than it does in men. This could be explained by a greater sensitivity to beta(2)-recepror stimulation in women than in men. METHODS Forearm blood flow was measured by venous occlusion plethysmography in healthy women (days 10 to 14 of the menstrual cycle) and in men. Drugs were administered via the brachial artery in three separate protocols: albuterol +/- N(G)-monomethyl-L-arginine tan inhibitor of nitric oxide synthase);substance P, nitroprusside and verapamil (control vasodilators);norepinephrine (+/- propranolol, a beta-adrenergic receptor antagonist). RESULTS Vasodilator responses to albuterol were greater in women than they were in men (p = 0.02 by analysis of variance). N(G)-monomethyl-L-arginine reduced these similarly in men and women. Responses to control vasodilators were less in women than they were in men teach p < 0.05). Norepinephrine caused less vasoconstriction in women than it did in men (p = 0.02). Propranolol did not influence basal flow in either gender nor responses of men to norepinephrine but increased vasoconstriction to each dose of norepinephrine in women (p < 0.0001 for interaction between gender and propranolol). Responses to norepinephrine coinfused with propranolol were similar in men and women. CONCLUSIONS Stimulation of beta(2)-adrenergic receptors causes greater forearm vasodilation in premenopausal women, at midmenstrual cycle, than it does in men. This is sufficient to explain why vasoconstriction to brachial artery norepinephrine is attenuated in such women. (J Am Coil Cardiol 2000;36:1233-8) (C) 2000 by the A

关键词：肾上腺素能α激动剂/投药和剂量肾上腺素能β激动剂/投药和剂量肾上腺素能β受体拮抗剂/投药和剂量沙丁胺醇/投药和剂量血流速度/药物作用肱动脉/药物作用肱动脉/生理学酶抑制剂/投药和剂量前臂/血液供给注射动脉内一氧化氮合酶/拮抗剂和抑制剂硝普钠/投药和剂量去甲肾上腺素/投药和剂量体积描记术普萘洛尔/投药和剂量受体肾上腺素能β2/药物作用参考值性征 P物质/投药和剂量血管阻力/药物作用血管阻力/生理学血管舒张/药物作用血管舒张药/投药和剂量维拉帕米/投药和剂量 ωN-甲基精氨酸/投药和剂量成年人女(雌)性人类男(雄)性

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Effects of trimetazidine on oxidant/antioxidant status in trinitrobenzenesulfonic acid-induced chronic colitis

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JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH-PART A-CURRENT ISSUES 2000年第8期59卷 641-652页

作者： Girgin, F Karaoglu, Ö Erkus, M Tüzün, S Özütemiz, Ö Dinçer, Ç Batur, Y Tanyalçin, T Ege Univ Sch Med Dept Biochem TR-35100 Izmir Turkey Ege Univ Sch Med Dept Gastroenterol Izmir Turkey Adnan Menderes Univ Sch Med Dept Pathol Aydin Turkey

Trimetazidine (TMZ), an anti-ischemic agent with proposed antioxidant properties, was used in a chronic colitis model in order to evaluate its effectiveness as a therapeutic agent in chronic colitis. Treatment of male Swiss Albino rats with ethanol (50%) and trinitrobenzenesulfonic acid (TNBS) (30 mg/kg) produced colitis as evidenced by histopathologic damage and inflammatory alterations, lipid peroxidation [increased malondialdehyde (MDA) levels], and enhanced neutrophil infiltration [increased myeloperoxidase (MPO) activity] without marked change in glutathione status. Administration of TMZ (5 mg/kg) to TNBS-treated rats failed to affect the TNBS-induced changes in histopathology and MPO activities. Unexpectedly, intrarectal (ir) administration of TMZ significantly elevated colonic MDA levels to a greater extent than TNBS alone. Intraperitoneal (ip) TMZ treatment seemed to increase total glutathione (tGSH), GSH, and GSH/GSSg values. In conclusion, our results demonstrated that (a) ir administration of ethanol and TNBS is an effective way of inducing a chronic colitis model, (b) inflammation and lipid peroxidation augment tissue damage in the chronic colitis model, (c) ip TMZ treatment significantly inhibits MDA production in the chronic colitis model, (d) TMZ treatment is more effective via the ip compared to ir route, and (e) TMZ seems to show its antioxidant effect via preserving the tissue's GSH/GSSG ratios.

关键词：投药直肠慢性病结肠炎/化学诱导结肠炎/药物疗法结肠炎/代谢结肠炎/病理学乙醇谷胱甘肽/代谢注射腹腔内脂质过氧化作用/药物作用丙二醛/代谢过氧化物酶/代谢大鼠 Sprague-Dawley 溶剂曲美他嗪/投药和剂量曲美他嗪/治疗应用三硝基苯磺酸血管舒张药/投药和剂量血管舒张药/治疗应用动物男(雄)性大鼠

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Coronary microcirculatory vasoconstriction during ischemia in patients with unstable angina

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第2期35卷 327-334页

作者： Marzilli, M Sambuceti, G Fedele, S L'Abbate, A CNR Inst Clin Physiol I-56100 Pisa Italy

OBJECTIVE To verify the behavior of coronary microvascular tone during spontaneous ischemia in patients with unstable angina (UA). BACKGROUND In UA, the pathogenetic role of vasoconstriction is classically confined at the stenotic coronary segment. However, microcirculatory vasoconstriction has been also suggested by previous experimental and clinical studies. METHODS The study included 10 patients with UA (recent worsening of anginal threshold and appearance of angina at rest) and single-vessel CAD. Blood flow velocity was monitored by a Doppler catheter in the diseased artery. Transstenotic pressure gradient was monitored by aortic and distal coronary pressure monitoring. Stenosis resistance was calculated as the ratio between pressure gradient and blood flow, microvascular resistance as the ratio between distal pressure and blood flow. Measurements were obtained at baseline, following intracoronary adenosine (2 mg) and during transient ischemia. Aortic and distal coronary pressures were also measured during balloon coronary occlusion. RESULTS Adenosine did not affect stenosis resistance, while it decreased (p < 0.05) microvascular resistance to 52 +/- 22% of baseline. Angina and ischemic ST segment shift were associated with transient angiographic coronary occlusion in 7 of 10 patients;however, in no case was ischemia associated with interruption of flow. Despite markedly different flow values, distal coronary pressure was similar during adenosine and during spontaneous ischemia (48 +/- 15 vs. 46 +/- 20 mm Hg, respectively, NS). During ischemia, a marked increase in the resistance of both coronary stenosis and coronary microcirculation was observed (to 1,233% +/- 1,298% and 671% +/- 652% of baseline, respectively, p < 0.05). Distal coronary pressure was markedly reduced during balloon coronary occlusion (14 +/- 7 mm Hg, p < 0.05 vs, both adenosine and ischemia), suggesting the absence of significant collateral circulation. CONCLUSIONS In patients with UA, transie

关键词：腺苷/投药和剂量心绞痛不稳定型/诊断显像心绞痛不稳定型/病理生理学血流速度血压冠状血管造影术冠状动脉循环/药物作用冠状动脉循环/生理学冠状血管/诊断显像冠状血管/药物作用冠状血管/病理生理学心电描记术注射动脉内心肌缺血/诊断显像心肌缺血/病理生理学疾病严重程度指数超声检查多普勒超声检查介入性血管阻力/药物作用血管收缩/药物作用血管舒张药/投药和剂量人类中年人

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Serum cholesterol level, cigarette smoking, and vasomotor responses to L-arginine in narrowed epicardial coronary arteries

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期85卷 500-503页

作者： Tentolouris, C Tousoulis, D Davies, GJ Stefanadis, C Toutouzas, P Univ London Imperial Coll Sci Technol & Med Sch Med Cardiol Unit Hammersmith Hosp London W12 0NN England Univ Athens Sch Med Cardiol Unit Hippokrat Hosp GR-11527 Athens Greece

It has been shown that infusion of L-arginine into the brachial artery augments endothelium-dependent forearm vasodilation and reverses the defective endothelium-dependent vasodilation associated with an elevated plasma low-density lipoprotein level or hypercholesterolemia.1–3 L-arginine administration improves the coronary blood flow response to acetylcholine in patients with normal coronary arteries and hypercholesterolemia.3 It enhances nitric oxide generation and inhibits lesion formation after balloon angioplasty.4,5 A recent study showed vasodilation of coronary stenoses with intracoronary L-arginine, and another demonstrated that L-arginine improves flow-mediated dilation in hypercholesterolemic subjects and smokers, but not in diabetic subjects.6–8 In this study we therefore have investigated the impact of smoking and hypercholesterolemia on the vasomotor effects of L-arginine in epicardial coronary arteries in patients with stable angina and coronary artery disease.

关键词：精氨酸/投药和剂量精氨酸/诊断应用生物学标记/血液胆固醇/血液冠状血管造影术冠状血管/药物作用冠状血管/病理生理学运动试验高胆固醇血症/血液高胆固醇血症/并发症注射动脉内硝酸甘油/投药和剂量硝酸甘油/诊断应用预后血管舒张/药物作用血管舒张药/投药和剂量血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Endothelium-dependent relaxation by acetylcholine is impaired in hypertriglyceridemic humans with normal levels of plasma LDL cholesterol

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期33卷 805-812页

作者： Lewis, TV Dart, AM Chin-Dusting, JPF Baker Med Res Inst Alfred & Baker Med Unit Prahran Vic 3181 Australia Alfred Hosp Prahran Vic 3181 Australia

OBJECTIVES. Patients with high triglyceride (of which very low density lipoproteins [VLDL] are the main carriers), but with normal low density lipoprotein (LDL) cholesterol levels, were examined for in vivo endothelium function status. BACKGROUND. Very low density lipoproteins inhibit endothelium-dependent, but not -independent, vasorelaxation in vitro. METHODS. Three groups were studied: Ij healthy volunteers (n = 10;triglyceride 1.24 +/- 0.14 mmol/liter, LDL cholesterol 2.99 +/- 0.24 mmol/liter);2) hypertriglyceridemic (n = 11;triglyceride 6.97 +/- 1.19 mmol/liter,* LDL cholesterol 2.17 +/- 0.2 mmol/liter,*p < 0.05);and 3) hypercholesterolemic (n = 10;triglyceride 2.25 +/- 0.29 mmol/liter,* LDL cholesterol 5.61 +/- 0.54 mmol/liter*;*p < 0.05) patients. Vasoactive responses to acetylcholine, sodium nitroprusside, noradrenaline, N-G monomethyl-l-arginine and postischemic hyperemia were determined using forearm venous occlusion plethysmography. RESULTS. Responses to acetylcholine (37 mu g/min) were significantly dampened both in hypercholesterolemic (% increase in forearm blood flow: 268.2 +/- 62) and hypertriglyceridemic patients (232.6 +/- 45.2)when compared with controls (547.8 +/- 108.9;ANOVA p < 0.05). Responses to sodium nitroprusside (at 1.6 mu g/min: controls a. hypercholesterolemics vs. hypertriglyceridemic: 168.7 +/- 25.1 vs. 140.6 +/- 38.9 vs. 178.5 +/- 54.5% increase), noradrenaline, N-G-monomethyl-L-arginine and postischemic hyperemic responses were not different among the groups examined. CONCLUSIONS. Acetylcholine responses are impaired in patients with pathophysiologic levels of plasma triglycerides but normal plasma levels of LDL cholesterol. The impairment observed was comparable to that obtained in hypercholesterolemic patients. We conclude that impaired responses to acetylcholine normally associated with hypercholesterolemia also occur in hypertriglyceridemia. These findings identify a potential mechanism by which high plasma triglyceride levels m

关键词：乙酰胆碱/投药和剂量血流速度/药物作用肱动脉/药物作用肱动脉/病理生理学胆固醇 LDL/血液内皮血管/药物作用内皮血管/病理生理学酶抑制剂/投药和剂量前臂/血液供给高胆固醇血症/血液高胆固醇血症/病理生理学高甘油三酯血症/血液高甘油三酯血症/病理生理学硝普钠/投药和剂量去甲肾上腺素/投药和剂量体积描记术甘油三酯类/血液血管收缩药/投药和剂量血管舒张/药物作用血管舒张药/投药和剂量 ωN-甲基精氨酸/投药和剂量成年人女(雌)性人类男(雄)性中年人

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Alpha-adrenoceptor blockade prevents exercise-induced vasoconstriction of stenotic coronary arteries

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1499-1505页

作者： Julius, BK Vassalli, G Mandinov, L Hess, OM Inselspital Bern Swiss Heart Ctr CH-3010 Bern Switzerland Univ Zurich Hosp Dept Internal Med Zurich Switzerland

OBJECTIVES The study aimed to evaluate the role of alpha-adrenergic mechanisms during dynamic exercise in both normal and stenotic coronary arteries. BACKGROUND Paradoxical vasoconstriction of stenotic coronary arteries has been reported during dynamic exercise and may be due to several factors such as alpha-adrenergic drive, a decreased release of nitric oxide, platelet aggregation with release of serotonin, or a passive collapse of the vessel wall. METHODS Twenty-six patients were studied at rest, during two levels of supine bicycle exercise and after 1.6 mg sublingual nitroglycerin The alpha-blocker phentolamine was given to 16 patients before exercise, five of whom had also taken a beta-adrenergic-blocker the same morning. Ten patients served as controls. The cross-sectional areas of a normal and a stenotic coronary vessel were determined by biplane quantitative coronary arteriography. RESULTS In the normal vessel segments, coronary cross-sectional area did not change after phentolamine injection, but increased in all patient groups similarly during exercise. Although coronary vasoconstriction existed in stenotic vessel segments in control patients, phentolamine-treated patients showed exercise-induced vasodilation without difference in Twenty-six patients were patients with and without chronic beta-blockade. CONCLUSIONS Exercise-induced vasoconstriction of stenotic coronary arteries is prevented by intracoronary administration of phentolamine There was no difference in coronary vasomotion between patients receiving phentolamine alone;md patients receiving phentolamine in addition to a beta-blocker. This finding suggests that exercise-induced vasoconstriction is mediated not only by endothelial dysfunction but also by alpha-adrenergic mechanisms. (C) 1999 by the American College of Cardiology.

关键词：肾上腺素能α拮抗剂/投药和剂量肾上腺素能α拮抗剂/副作用肾上腺素能β受体拮抗剂/投药和剂量肾上腺素能β受体拮抗剂/副作用阿替洛尔/投药和剂量阿替洛尔/副作用冠状血管造影术/药物作用冠状动脉循环/药物作用冠状动脉循环/生理学冠心病/药物疗法冠心病/病理生理学运动试验/药物作用血流动力学/药物作用美托洛尔/投药和剂量美托洛尔/副作用硝酸甘油/投药和剂量硝酸甘油/副作用酚妥拉明/投药和剂量酚妥拉明/副作用术前用药法血管收缩/药物作用血管收缩/生理学血管舒张药/投药和剂量血管舒张药/副作用成年人老年人女(雌)性人类男(雄)性中年人

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Repeated stunning precedes myocardial hibernation in progressive multiple coronary artery obstruction

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期34卷 2126-2136页

作者： Shivalkar, B Flameng, W Szilard, M Pislaru, S Borgers, M Vanhaecke, J Katholieke Univ Leuven Dept Cardiol & Cardiac Surg Louvain Belgium Katholieke Univ Leuven Lab Expt Cardiol Louvain Belgium Katholieke Univ Leuven Lab Expt Cardiac Surg & Anesthesiol Louvain Belgium Janssen Res Fdn B-2340 Beerse Belgium Univ Maastricht Maastricht Netherlands

OBJECTIVE The aim of this study was to characterize a regional myocardial flow-function relationship in collateral dependent myocardium produced by multiple coronary artery obstruction. METHODS Ameroid constrictors were placed around the proximal right (RC) and circumflex (CX) coronary arteries and a silicon tubing cuff around the proximal LAD (left anterior descending artery) (luminal stenosis +/-77%) in 18 dogs. Weekly two-dimensional echocardiography was performed for regional function (anterior [A], inferoposterior [IP], wall thickening [WT]), and fractional shortening (FS). Colored microspheres injected at baseline and before sacrifice, before and after dipyridamole (0.5 mg/kg) injection, determined resting flow (RF) and coronary reserve (CR), respectively. RESULTS Coronary angiography performed at four weeks after surgery confirmed occlusion of RC and CX with collateralization and a tight stenosis of LAD. Initially, an episodic reduction in A and IP WT was observed which became persistent later (AWT: 16 +/- 3%;IPWT: 16 +/- 4%, FS: 20 +/- 4%, p < 0.005 vs, baseline [BS]). With dobutamine a biphasic response (improvement in A and IP WT between 5-15 and dysfunction between 20-30 mu g/kg/min) was observed. Seven dogs were sacrificed at eight weeks and showed normal RF but reduced transmural CR (A: 75 +/- 18%;IF: 46 +/- 22% of control). Seven dogs underwent PTCA of the LAD at eight weeks and showed gradual improvement in AWT with normalization at 12 weeks (AWT: 30 +/- 5%, p < 0.001 vs, eight weeks). At sacrifice RF and CR in the A wall were normal but there was reduced subendocardial RF in the IP region (64% of BS). Further, biopsy samples showed normal histological findings and high energy phosphate content in all dogs. Radioligand binding assays using I-125-iodocyanopindolol showed downregulation of beta-adrenergic receptor density in the dysfunctional regions compared with control. CONCLUSIONS In this canine model of viable, collateral dependent and reversibly d

关键词：强心药/投药和剂量侧支循环/药物作用冠状动脉循环/药物作用冠心病/并发症冠心病/诊断冠心病/病理生理学疾病模型动物疾病恶化超声心动描记术心室/病理学心室/病理生理学注射静脉内缺血预处理心肌心肌血管重建术/方法心肌顿抑/诊断心肌顿抑/病因学心肌顿抑/病理生理学受体肾上腺素能β/代谢局部血流/药物作用血管舒张药/投药和剂量动物狗女(雌)性男(雄)性

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Three minute, but not one minute, ischemia and nicorandil have a preconditioning effect in patients with coronary artery disease

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第2期35卷 345-351页

作者： Matsubara, T Minatoguchi, S Matsuo, H Hayakawa, K Segawa, T Matsuno, Y Watanabe, S Arai, M Uno, Y Kawasaki, M Noda, T Takemura, G Nishigaki, K Fujiwara, H Gifu Univ Sch Med Dept Internal Med 2 Gifu 500 Japan Gifu Prefectural Hosp Dept Cardiol Gifu Japan

OBJECTIVES This study focused on 1) the determination of the optimal preconditioning (PC) duration, and 2) the protective effect of nicorandil (NC), a hybrid nitrate with a KATP channel opening effect, during a percutaneous transluminal coronary angioplasty (PTCA) model in humans. BACKGROUND The ischemic PC effect is induced in 180 s ischemia, but not in 120 s ischemia in rabbit hearts. However, the duration of ischemia that induces PC effect and the role of the KATP channel in the PC effect in humans are still unclear. METHODS Forty-six patients with stable angina were randomly allocated to four groups: the duration of the first inflation as PC ischemia was 60 s in the PC60 group (n = 12), and 180 s in the PC180 group (n = 12). In the other groups, NC (80 mu g/kg) was intravenously given for 1 min in the NC group (n = 12), and isosorbide dinitrate (ISDN) (40 mu g/kg) was given in the ISDN group (n = 10). Five minutes after first inflation or drug administration, a second inflation was conducted for 120 s in each group. In the EGG, the lead with the largest shift in ST segment (deltaST max), and the sum of elevated ST levels in all leads (sigmaST) were determined. RESULTS In the PC60 group, no significant difference was observed in either deltaST max or sigmaST between the first and second inflation. However;the second inflation in the PC180 group showed significantly lower levels of deltaST max and sigmaST compared with those of the first inflation. In the NC group, both deltaST max and sigmaST measured at 30 s and 60 s after balloon inflation were significantly lower than those of the first inflation in the PC60 and PC180 control groups. In the ISDN group, no significant difference was observed in deltaST max or sigmaST. CONCLUSION In human PTCA models, a PC effect is observed in 180 s ischemia, but not in 60 s ischemia. A pharmacological PC effect is induced by NC, a KATP channel opener with a nitrate-like effect but not ISDN. This suggests that the Opening of KA

关键词：心绞痛/诊断显像心绞痛/治疗血管成形术气囊冠状动脉冠状血管造影术心电描记术血流动力学注射静脉内缺血预处理心肌/方法硝酸异山梨酯/投药和剂量硝酸异山梨酯/治疗应用尼可地尔/投药和剂量尼可地尔/治疗应用时间因素治疗结果血管舒张药/投药和剂量血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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Preconditioning during percutaneous transluminal coronary angioplasty by endogenous and exogenous adenosine

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AMERICAN HEART JOURNAL 2000年第5期140卷 813-820页

作者： Heidland, UE Heintzen, MP Schwartzkopff, B Strauer, BE Univ Dusseldorf Dept Cardiol Pneumol & Angiol Sch Internal Med D-40225 Dusseldorf Germany

Background The purpose of this study was to assess whether pharmacologic preconditioning by exogenous or endogenous adenosine prevents the deterioration of hemodynamic function and left ventricular performance during percutaneous transluminal coronary angioplasty (PTCA). Ischemic preconditioning renders the heart more resistant to subsequent ischemia. Adenosine plays a key role in its pathogenesis. Coronary angioplasty is a suitable model for the induction of myocardial ischemia. Methods and Results We investigated 30 patients receiving PTCA of the left anterior descending coronary. Patients were randomly allocated to either dipyridamole, leading to the liberation of endogenous adenosine (0.5 mg/kg body weight, intracoronary), exogenous adenosine (20 mg intracoronary), or an equal amount of saline. Chest pain, tolerated inflation time, and ST-segment shift were registered. Left ventricular hemodynamics, isovolumetric phase indexes, indexes of volume, election fraction, and indexes of diastolic dysfunction were analyzed. Patients receiving endogenous or exogenous adenosine tolerated longer balloon inflation times (dipyridamole, 208 +/- 23 seconds;adenosine, 188 +/- 41 seconds;control, 153 +/- 36 seconds;P < .05). Deterioration of left ventricular ejection fraction was less severe after adenosine (72% +/- 5% before PTCA vs 64% +/- 6% during angioplasty;P = .11) and could be prevented by intracoronary dipyridamole (69% +/- 12% before PTCA vs 68% +/- 11% after PTCA;P < .01) compared with the control group (71% +/- 7% before PTCA vs 60% +/- 7% during angioplasty). Conclusions Intracoronary application of exogenous adenosine and liberation of endogenous adenosine increase the tolerance to ischemia and prevent deterioration of left ventricular function during ischemia. These findings can be attributed to ischemic preconditioning. However, endogenous adenosine exceeds the protective effects of exogenous adenosine.

关键词：腺苷/投药和剂量腺苷/代谢血管成形术经腔经皮冠状动脉/方法混杂因素(流行病学) 冠状血管造影术双嘧达莫/治疗应用缺血预处理心肌/方法心肌收缩/药物作用血小板聚集抑制剂/治疗应用每搏输出量/药物作用时间因素治疗结果血管舒张药/投药和剂量心室功能障碍左/代谢心室功能障碍左/病理学心室功能左/药物作用老年人女(雌)性人类男(雄)性中年人

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