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Kim M, Jang AY, Oh PC, Suh SY, Lee K, Kang WC, Ahn T, Han SH. Diagnostic and prognostic role of nitroglycerin-induced dilation in patients with suspected vasospastic angina, combined with ergonovine provocation test. Sci Rep 2021; 11:23834. [PMID: 34903772 PMCID: PMC8668896 DOI: 10.1038/s41598-021-03338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
The diagnostic and prognostic role of nitroglycerin-induced dilation (NID) combined with ergonovine provocation test in patients with suspected VSA patients is not clear. A total of 438 consecutive patients who underwent the ergonovine provocation test for the diagnosis of vasospastic angina (VSA) were enrolled. Patients with VSA (n = 52) had a significantly greater coronary response to ergonovine (− 84.3 ± 10.5% vs. − 38.4 ± 17.9%, p < 0.001) and NID (26.3 ± 31.0% vs. 12.5 ± 19.0%, p < 0.001) than non-VSA patients. However, positive NID (more than 13.8% dilation, n = 170) showed a poor accuracy (AUC 0.64 [95% CI: 0.56–0.73], p = 0.001, sensitivity 60.4%, specificity 61.3%) for the diagnosis of VSA by ergonovine provocation test. Major adverse cardiovascular events (MACE) occurred more frequently in the VSA group than in the non-VSA group (9.6% vs. 2.2%, p = 0.006). In addition, the positive NID group showed a lower rate of MACE than the negative NID group (1.2% vs. 4.3%, p = 0.021). Interestingly, the group of VSA with negative NID had poor prognosis than any other combinations (Log-rank, p < 0.0001). Although NID had a limited role in the detection of VSA defined by ergonovine provocation test, NID combined with the ergonovine provocation test has an additive prognostic role in the clinical outcomes in patients with suspected VSA.
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Affiliation(s)
- Minsu Kim
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Kyounghoon Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Taehoon Ahn
- Division of Cardiovascular Diseases, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Republic of Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
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Impact of multi-vessel vasospastic angina on cardiovascular outcome. Atherosclerosis 2019; 281:107-113. [DOI: 10.1016/j.atherosclerosis.2018.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/20/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022]
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Kinjo T, Tanaka M, Osanai T, Shibutani S, Narita I, Tanno T, Nishizaki K, Ichikawa H, Kimura Y, Ishida Y, Yokota T, Shimada M, Homma Y, Tomita H, Okumura K. Enhanced p122RhoGAP/DLC-1 Expression Can Be a Cause of Coronary Spasm. PLoS One 2015; 10:e0143884. [PMID: 26624289 PMCID: PMC4666625 DOI: 10.1371/journal.pone.0143884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/10/2015] [Indexed: 01/17/2023] Open
Abstract
Background We previously showed that phospholipase C (PLC)-δ1 activity was enhanced by 3-fold in patients with coronary spastic angina (CSA). We also reported that p122Rho GTPase-activating protein/deleted in liver cancer-1 (p122RhoGAP/DLC-1) protein, which was discovered as a PLC-δ1 stimulator, was upregulated in CSA patients. We tested the hypothesis that p122RhoGAP/DLC-1 overexpression causes coronary spasm. Methods and Results We generated transgenic (TG) mice with vascular smooth muscle (VSM)-specific overexpression of p122RhoGAP/DLC-1. The gene and protein expressions of p122RhoGAP/DLC-1 were markedly increased in the aorta of homozygous TG mice. Stronger staining with anti-p122RhoGAP/DLC-1 in the coronary artery was found in TG than in WT mice. PLC activities in the plasma membrane fraction and the whole cell were enhanced by 1.43 and 2.38 times, respectively, in cultured aortic vascular smooth muscle cells from homozygous TG compared with those from WT mice. Immediately after ergometrine injection, ST-segment elevation was observed in 1 of 7 WT (14%), 6 of 7 heterozygous TG (84%), and 7 of 7 homozygous TG mice (100%) (p<0.05, WT versus TGs). In the isolated Langendorff hearts, coronary perfusion pressure was increased after ergometrine in TG, but not in WT mice, despite of the similar response to prostaglandin F2α between TG and WT mice (n = 5). Focal narrowing of the coronary artery after ergometrine was documented only in TG mice. Conclusions VSM-specific overexpression of p122RhoGAP/DLC-1 enhanced coronary vasomotility after ergometrine injection in mice, which is relevant to human CSA.
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Affiliation(s)
- Takahiko Kinjo
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Makoto Tanaka
- Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomohiro Osanai
- Department of Health Promotion, Hirosaki University Graduate School of Health Science, Hirosaki, Japan
| | - Shuji Shibutani
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ikuyo Narita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomohiro Tanno
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroaki Ichikawa
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihiro Kimura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takashi Yokota
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Michiko Shimada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshimi Homma
- Department of Biomolecular Science, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Okumura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- * E-mail:
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4
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Keskin A, Winkler R, Mark B, Kilkowski A, Bauer T, Koeth O, Camci S, Cornelius B, Layer G, Zeymer U, Zahn R. Tako-tsubo cardiomyopathy after administration of ergometrine following elective caesarean delivery: a case report. J Med Case Rep 2010; 4:280. [PMID: 20727147 PMCID: PMC2933634 DOI: 10.1186/1752-1947-4-280] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 08/20/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Tako-tsubo cardiomyopathy (stress-induced cardiomyopathy or transient left ventricular ballooning) is characterized by clinical suspicion of an acute myocardial infarction with transient apical or midventricular dyskinesia of the left ventricle without significant coronary stenosis on angiography. The etiology of this disease remains obscure. One of the possible causes is myocardial ischemia induced by coronary vasospasm due to sympathetic activation. It has been hypothesized that the application of ergometrine could induce tako-tsubo cardiomyopathy. Case presentation We report the case of a 28-year-old Turkish woman who developed tako-tsubo cardiomyopathy after administration of ergometrine for release of placenta and prevention of bleeding during the post-partum phase in the course of an elective caesarean delivery. Tako-tsubo cardiomyopathy was diagnosed by echocardiography and urgent cardiac magnetic resonance imaging. A coronary angiography was not performed because of the absence of myocardial necrosis or ischemia and signs of myocarditis on cardiac magnetic resonance imaging. Conclusion This life-threatening disease should be excluded in the differential diagnosis by comparing the symptoms with those of typical heart failure, particularly after use of ergometrine.
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Affiliation(s)
- Abdulgazi Keskin
- Department of Cardiology (Herzzentrum Ludwigshafen), Hospital Ludwigshafen, Academic Teaching Hospital of Johannes-Gutenberg-University of Mainz, Ludwigshafen am Rhein, Germany.
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Kim JW, Park CG, Seo HS, Oh DJ. Delayed severe multivessel spasm and aborted sudden death after Taxus stent implantation. Heart 2005; 91:e15. [PMID: 15657205 PMCID: PMC1768681 DOI: 10.1136/hrt.2004.049932] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sudden cardiac arrest associated with major spasm of three coronary arteries was observed about 10 hours after Taxus stent insertion in a three vessel lesion and was successfully treated by intracoronary glyceryl trinitrate infusion. This case illustrates a potential risk associated with drug eluting stent and alerts clinicians to the life threatening risk of spasm when stenting multiple vessels with drug eluting stent (especially the Taxus stent).
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Affiliation(s)
- J W Kim
- Department of Cardiology, Guro Hospital Cardiovascular Centre, Korea University, Seoul, South Korea
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6
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Miki T, Suzuki M, Shibasaki T, Uemura H, Sato T, Yamaguchi K, Koseki H, Iwanaga T, Nakaya H, Seino S. Mouse model of Prinzmetal angina by disruption of the inward rectifier Kir6.1. Nat Med 2002; 8:466-72. [PMID: 11984590 DOI: 10.1038/nm0502-466] [Citation(s) in RCA: 269] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The inwardly rectifying K(+) channel Kir6.1 forms K(+) channels by coupling with a sulfonylurea receptor in reconstituted systems, but the physiological roles of Kir6.1-containing K(+) channels have not been determined. We report here that mice lacking the gene encoding Kir6.1 (known as Kcnj8) have a high rate of sudden death associated with spontaneous ST elevation followed by atrioventricular block as seen on an electrocardiogram. The K(+) channel opener pinacidil did not induce K(+) currents in vascular smooth-muscle cells of Kir6.1-null mice, and there was no vasodilation response to pinacidil. The administration of methylergometrine, a vasoconstrictive agent, elicited ST elevation followed by cardiac death in Kir6.1-null mice but not in wild-type mice, indicating a phenotype characterized by hypercontractility of coronary arteries and resembling Prinzmetal (or variant) angina in humans. The Kir6.1-containing K(+) channel is critical in the regulation of vascular tonus, especially in the coronary arteries, and its disruption may cause Prinzmetal angina.
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MESH Headings
- Angina Pectoris, Variant/genetics
- Angina Pectoris, Variant/physiopathology
- Animals
- Aorta, Thoracic
- Blood Pressure
- Coronary Vessels/drug effects
- Coronary Vessels/physiopathology
- Disease Models, Animal
- Electrocardiography
- Flavoproteins/metabolism
- Glyburide/pharmacology
- Heart/drug effects
- Heart/physiopathology
- Heart Ventricles
- In Situ Hybridization
- Mice
- Mice, Knockout
- Muscle Contraction/physiology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/physiopathology
- Oxidation-Reduction
- Potassium Channels, Inwardly Rectifying/deficiency
- Potassium Channels, Inwardly Rectifying/genetics
- Potassium Channels, Inwardly Rectifying/physiology
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Affiliation(s)
- Takashi Miki
- Department of Cellular and Molecular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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7
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Ishida T, Kawashima S, Sakoda T, Shimokawa Y, Miwa Y, Inoue N, Ueyama T, Shiomi M, Akita H, Yokoyama M. Serotonin-induced hypercontraction through 5-hydroxytryptamine 1B receptors in atherosclerotic rabbit coronary arteries. Circulation 2001; 103:1289-95. [PMID: 11238275 DOI: 10.1161/01.cir.103.9.1289] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Augmented vasoconstriction to serotonin (5-hydroxytryptamine [5-HT]) in atherosclerotic vessels plays a crucial role in the development of myocardial ischemia. We investigated mechanisms for serotonin-evoked hypercontraction in atherosclerotic rabbit coronary arteries. METHODS AND RESULTS Contractile responses to serotonergic agents of endothelium-denuded coronary arteries from control and Watanabe heritable hyperlipidemic rabbits (WHHL) were examined. WHHL coronary arteries exhibited hypercontraction to 5-HT(1)-receptor agonists; the constrictor threshold concentrations and E:D(50) to serotonin, 5-carboxamidotryptamine, and sumatriptan in WHHL were significantly lower, and the E:(max) in WHHL to these agents were increased 55% to 59% above those of the control. Serotonin-evoked contractions in both groups were inhibited by GR127935 (5-HT(1B/1D) antagonist; 0.1 to 1 nmol/L) and pertussis toxin but not by ketanserin (5-HT(2) antagonist; 0.01 to 1 micromol/L), suggesting that the hypercontraction is most likely mediated by 5-HT(1B/1D) receptors through a pertussis toxin-sensitive pathway. Furthermore, simultaneous measurements of [Ca(2+)](i) and isometric tension of fura-2-loaded arteries revealed that the hypercontraction was concomitant with the augmented elevation of [Ca(2+)](i) in the smooth muscle. The 5-HT(1B) mRNA levels in WHHL coronary arteries increased to 2.5-fold over those in control arteries, whereas neither 5-HT(1D) nor 5-HT(2A) mRNA was detected in either group. CONCLUSIONS Atherosclerotic rabbit coronary arteries exhibited the enhancement in contraction and Ca(2+) mobilization in response to serotonin. The 5-HT(1B) receptor, which is upregulated by atherosclerosis, most likely mediates the augmenting effects of serotonin.
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Affiliation(s)
- T Ishida
- First Department of Internal Medicine and Institute for Experimental Animals, Kobe (Japan) University School of Medicine
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8
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Carel I, Ghaleh B, Edouard A, Dubois-Rande JL, Parsons AA, Giudicelli JF, Berdeaux A. Comparative effects of frovatriptan and sumatriptan on coronary and internal carotid vascular haemodynamics in conscious dogs. Br J Pharmacol 2001; 132:1071-83. [PMID: 11226138 PMCID: PMC1572655 DOI: 10.1038/sj.bjp.0703917] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The effects of frovatriptan and sumatriptan on internal carotid and coronary vascular haemodynamics were investigated and compared in conscious dogs. Frovatriptan and sumatriptan (0.1 - 100 microg kg(-1)) induced a transient increase in external coronary artery diameter (eCOD) of up to 2.9+/-1.2 and 1.8+/-0.6%, respectively (both P:<0.05). This was followed by a prolonged and dose-dependent decrease in eCOD of up to -5.2+/-1.2 and -5.3+/-0.9% (both P:<0.05), with ED(50) values of 86+/-21 and 489+/-113 micromol kg(-1), respectively. In contrast, only a decrease in the external diameter of the internal carotid artery was observed (-6.0+/-0.6 and -6.2+/-1.4%, both P:<0.05, and ED(50) values of 86+/-41 and 493+/-162 micromol kg(-1), respectively). Frovatriptan was thus 5.7 fold more potent than sumatriptan at the level of both large coronary and internal carotid arteries. After endothelium removal by balloon angioplasty in coronary arteries, the initial dilatation induced by the triptans was abolished and delayed constriction enhanced. The selective antagonist for the 5-HT(1B) receptors SB224289 dose-dependently blocked the effects of sumatriptan on large coronary and internal carotid arteries whereas the selective antagonist for the 5-HT(1D) receptors BRL15572 did not affect any of these effects. In conclusion, frovatriptan and sumatriptan initially dilate and subsequently constrict large coronary arteries in the conscious dog, whereas they directly constrict the internal carotid artery. The vascular endothelium modulates the effects of these triptans on large coronary arteries. Finally, 5-HT(1B) but not 5-HT(1D) receptors are primarily involved in canine coronary and internal carotid vasomotor responses to sumatriptan.
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Affiliation(s)
- Ivan Carel
- Département de Pharmacologie, Faculté de Médecine Paris Sud and INSERM E 00.01, 63 rue Gabriel Péri, 94276 Le Kremlin Bicêtre Cedex, France
| | - Bijan Ghaleh
- Département de Pharmacologie, Faculté de Médecine Paris Sud and INSERM E 00.01, 63 rue Gabriel Péri, 94276 Le Kremlin Bicêtre Cedex, France
| | - Alain Edouard
- Département de Pharmacologie, Faculté de Médecine Paris Sud and INSERM E 00.01, 63 rue Gabriel Péri, 94276 Le Kremlin Bicêtre Cedex, France
| | - Jean-Luc Dubois-Rande
- Service de Cardiologie and INSERM U 400, Hôpital Henri Mondor, 8 rue du Général Sarrail, 94010 Créteil Cedex-France
| | - Andrew A Parsons
- Neuroscience Research, SmithKline Beecham Pharmaceuticals, New Frontiers Science Park North, Third Avenue, Harlow, Essex CM19 5AW
| | - Jean-François Giudicelli
- Département de Pharmacologie, Faculté de Médecine Paris Sud and INSERM E 00.01, 63 rue Gabriel Péri, 94276 Le Kremlin Bicêtre Cedex, France
- Author for correspondence:
| | - Alain Berdeaux
- Département de Pharmacologie, Faculté de Médecine Paris Sud and INSERM E 00.01, 63 rue Gabriel Péri, 94276 Le Kremlin Bicêtre Cedex, France
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9
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Nakamura M. Our animal model of coronary spasm--my personal view. J Atheroscler Thromb 2000; 6:1-12. [PMID: 10870675 DOI: 10.5551/jat1994.6.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We developed an animal model of coronary spasm in swine, similar to coronary spasm in patients with variant angina based on the angiographic findings. In this animal model, an impairment of endothelium dependent dilatation appeared to play a minor role while the hypercontraction of the medial muscle cells by histamine and serotonin at the spastic site played a major role in the induction of coronary spasm. In Göttingen male miniature swine receiving focal endothelial denudation, moderate hypercholesterolemia and X ray irradiation, the abrupt, severe and prolonged coronary spasm resulted in a sudden progression of organic coronary stenosis mainly due to intraplaque hemorrhage and also in acute myocardial infarction.
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Affiliation(s)
- M Nakamura
- The Graduate School of Health and Nutrition Sciences, Nakamura Gakuen University, Fukuoka, Japan
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10
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Karila-Cohen D, Delpy E, Dubois-Randé JL, Puybasset L, Hittinger L, Giudicelli JF, Berdeaux A. Influence of the endothelium, nitric oxide and serotonergic receptors on coronary vasomotor responses evoked by ergonovine in conscious dogs. Br J Pharmacol 1999; 127:1039-47. [PMID: 10433513 PMCID: PMC1566101 DOI: 10.1038/sj.bjp.0702635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
1. The respective contributions of coronary vascular endothelium, nitric oxide (NO) and serotonergic receptors to the effects of ergonovine on large and small coronary arteries were investigated in conscious dogs. 2. In seven dogs with an endothelium intact, ergonovine (30 - 1000 microg, i.v.) induced a biphasic response on large coronary artery with an early and transient vasodilatation (up to +2.9+/-0.5% from 3310+/-160 microm, P<0.01) followed by a sustained vasoconstriction (down to -4.9+/-0.5%, P<0.001) which occurred simultaneously with a sustained increase in coronary blood flow (CBF) (up to +100+/-26% from 28+/-4 ml min(-1), P<0.001). After endothelium removal (balloon angioplasty), the ergonovine-induced vasodilatation was abolished and vasoconstriction potentiated (-6.4+/-0.9% after vs -4.9+/-0.5% before endothelium removal, P<0.01). 3. After blockade of NO synthesis by Nomega-nitro-L-arginine (30 mg kg(-1)) in four other dogs, the early vasodilatation induced by ergonovine was abolished but the delayed vasoconstriction as well as the increase in CBF remained unchanged. 4. Both ketanserin and methiothepin (0.3 mg kg(-1)) abolished the early vasodilatation and reduced the delayed vasoconstriction induced by ergonovine. Ketanserin decreased and methiothepin abolished the reduction in coronary resistance induced by ergonovine. 5. Thus, the complex interactions between vascular endothelium and serotonergic receptors to ergonovine-induced constriction of large coronary arteries might explain the induction of coronary spasms in patients with endothelial dysfunction.
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Affiliation(s)
- D Karila-Cohen
- Département de Pharmacologie, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, France
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11
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Muroya T, Ohe H, Sakai H, Harada T, Numata T, Ohe N, Ikeda S, Miyahara Y, Kohno S. A case in which stent insertion is considered to have triggered contrast medium-induced coronary vasospasm. JAPANESE CIRCULATION JOURNAL 1999; 63:315-8. [PMID: 10475782 DOI: 10.1253/jcj.63.315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A Gianturco-Roubin II (GR-II) stent was inserted in a 75-year-old man who developed restenosis of the right coronary artery (RCA) after percutaneous transluminal coronary angioplasty (PTCA). Although the vessel became partially occluded after 7 months, it was redilated by PTCA. Follow-up angiography of the RCA and left coronary artery (LCA) was performed 3 months later. Chest pain with bradycardia and hypotension occurred immediately after this examination, and ST elevation appeared in ECG leads II, III, and aVF. Repeat angiography of the RCA confirmed complete occlusion due to a spasm at a site proximal to the GR-II stent. The spasm was resolved by intracoronary infusion of isosorbide dinitrate (ISDN), and PTCA was carried out for extensive recurrent restenosis of the RCA; however, vascular dissection developed at the distal end of the GR-II stent. Therefore, a Palmaz-Schatz (P-S) stent was placed such that its proximal end overlapped the distal end of the GR-II stent. Follow-up angiography 3 months later showed no restenosis, but an episode of vasospasm similar to the previous one occurred immediately after left ventriculography. The RCA was completely occluded proximal to the GR-II stent because of spasm. Although this spasm was gradually relieved by intracoronary infusion of ISDN, marked spasm was also observed distal to the P-S stent; complete relief was achieved by infusion of additional ISDN.
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Affiliation(s)
- T Muroya
- Department of Cardiology, Kitakyushu City Yahata Hospital, Fukuoka, Japan
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12
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Watts SW. The development of enhanced arterial serotonergic hyperresponsiveness in mineralocorticoid hypertension. J Hypertens 1998; 16:811-22. [PMID: 9663921 DOI: 10.1097/00004872-199816060-00012] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate that the receptor in the rat mesenteric artery mediating contraction in response to 5-hydroxytryptamine switches from a 5-hydroxytryptamine-2A to a 5-hydroxytryptamine-2B receptor after 4 weeks of deoxycorticosterone and salt (1.0% NaCl plus 0.2% KCl) therapy, and, as an extension of these studies, to test the hypothesis that this switch occurs prior to the development of hypertension. DESIGN Rats were administered deoxycorticosterone-salt therapy or no therapy for 1, 3, 5, 7, or 28 days. Additionally, four groups of rats (sham-normal salt, sham-high salt, deoxycorticosterone-normal salt, and deoxycorticosterone-high salt) were administered therapy for 4 weeks (28 days) to distinguish between the roles of salt and blood pressure in serotonergic responsiveness. METHODS Superior mesenteric arteries were mounted in tissue baths for measurement of isometric contractile force; systolic blood pressure was measured by a tail-cuff method. RESULTS Systolic blood pressure was first elevated by deoxycorticosterone-salt therapy relative to that in sham controls on day 5. Contraction in response to phenylephrine was minimally altered after 7 days of deoxycorticosterone-salt therapy. By day 3, the tryptophan metabolite and putative 5-hydroxytryptamine-2B receptor agonist kynuramine contracted hypertensive arteries to a greater maximum (percentage of contraction induced by phenylephrine for rats administered deoxycorticosterone-salt therapy 48.5 +/- 16.0%) than that observed for arteries in sham-treated rats (9.7 +/- 6.2%); this was also observed for the ergot alkaloid ergonovine (deoxycorticosterone-salt 67.1 +/- 18.5% and sham treatment 14.5 +/- 9.1%); however, increase in reactivity to 5-hydroxytryptamine began on day 5. Ketanserin (a 5-hydroxytryptamine-2A antagonist with a low affinity for 5-hydroxytryptamine-2B receptor; 30 nmol/l) competitively inhibited contraction in response to 5-hydroxytryptamine of mesenteric arteries from sham-treated and deoxycorticosterone-salt-treated rats on days 1, 3, and 5 but had less effect on arteries in deoxycorticosterone-salt-treated rats by day 7, signifying that a change to a non-5-hydroxytryptamine-2A receptor had occurred. Sensitivities to 5-hydroxytryptamine and to ergonovine of deoxycorticosterone-treated rats fed a normal or high-salt diet for 28 days tended to increase, as did those of sham-treated rats fed a high-salt diet (with normal blood pressure). Contraction in response to phenylephrine was changed in arteries only from animals whose systolic blood pressure had been increased (deoxycorticosterone-normal salt and deoxycorticosterone-high salt groups). CONCLUSIONS These experiments support the hypothesis that the switch to ketanserin-insensitive 5-hydroxytryptamine-2 receptors likely occurs coincident with or just after the initial increase in blood pressure in the deoxycorticosterone-salt-treated rat.
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Affiliation(s)
- S W Watts
- Department of Pharmacology and Toxicology, Michigan State University, E. Lansing 48824-1317, USA.
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Hermsmeyer K, Miyagawa K, Kelley ST, Rösch J, Hall AS, Axthelm MK, Greenberg B. Reactivity-based coronary vasospasm independent of atherosclerosis in rhesus monkeys. J Am Coll Cardiol 1997; 29:671-80. [PMID: 9060910 DOI: 10.1016/s0735-1097(96)00524-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We studied the hypothesis that in the absence of vascular pathology, coronary artery vasospasm occurs as a result of local regions of vascular muscle hyperreactivity. We aimed to explore the basis for a functional etiology of those vasospasms not explained on a structural basis. BACKGROUND Ovariectomized rhesus monkeys (Macaca mulatta) without injury or significant vascular disease were stimulated with platelet release products, and angiograms were compared with those from vasospasms induced in human patients. METHODS We used intracoronary (IC) injections of serotonin, thromboxane A2 (U46619), endothelin 1 or angiotensin II in concentrations 3 to 10 times that which reduced coronary artery diameter by 50%. RESULTS Although no agent alone caused vasospasm, the combination of pathophysiologic concentrations of serotonin and the stable thromboxane A2 mimetic, U46619, injected through an IC catheter, synergistically caused coronary vasospasm on the second or third challenge in five of seven monkeys. These drug-induced vasospasms were similar to vasospasms induced by mechanical injury followed by serotonin, and to those stimulated in human IC diagnostic tests, as judged by onset, appearance, kinetics and vasodilator reversal. CONCLUSIONS These studies in ovariectomized monkeys revealed that coronary vasospasm can be stimulated without preexisting vascular pathology, endothelial denudation or injury. Reproducible vasospasm of primate coronary arteries in response to these two endogenous pathophysiologic vasoconstrictors, which are thought to be precipitating stimuli in the etiology of vasospasm, suggests that structure-independent epicardial vasospasm can be an important element in serious cardiac ischemic events, particularly the focal, persistent vasospasms that occur without plaques or injury.
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Affiliation(s)
- K Hermsmeyer
- Oregon Regional Primate Research Center, Beaverton 97006, USA
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Jong-Koo Lee S, Park SJ, Park SW, Kim JJ, Song JK, Hong MK, Kang DH, Cheong SS. Increased basal tone and hyperresponsiveness to acetylcholine and ergonovine in spasm-related coronary arteries in patients with variant angina. Int J Cardiol 1996. [DOI: 10.1016/0167-5273(96)02616-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Yano S, Shimada K. Vasospastic angina after chemotherapy by with carboplatin and etoposide in a patient with lung cancer. JAPANESE CIRCULATION JOURNAL 1996; 60:185-8. [PMID: 8741246 DOI: 10.1253/jcj.60.185] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report here a case of vasospastic angina following the administration of Carboplatin (CBDCA) and Etoposide (VP-16) in a patient with small cell lung carcinoma. Although these drugs are commonly used to treat small cell lung carcinoma, there has been no previous report of vasospastic angina in a patient without a history of heart disease. Therefore, we should be aware of the possibility that vasospastic angina may develop even in a patient without any history of heart disease. While calcium antagonist and isosorbide dinitrate are generally helpful for preventing vasospastic angina, these drugs could not completely suppress vasospastic angina in this case.
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Affiliation(s)
- S Yano
- Department of Pulmonary Medicine, Shiga Prefectural Medical Center, Japan
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16
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Woodman OL. Modulation of vasoconstriction by endothelium-derived nitric oxide: the influence of vascular disease. Clin Exp Pharmacol Physiol 1995; 22:585-93. [PMID: 8542668 DOI: 10.1111/j.1440-1681.1995.tb02071.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
1. The endothelium makes a significant contribution to the regulation of vascular tone through the release of potent vasodilator agents such as nitric oxide (NO) and prostacyclin (PGI2) as well as vasoconstrictor compounds such as endothelin. Recognition of this function of the endothelium has created a new focus for the investigation of vasoconstrictor activity under physiological and pathological conditions. 2. It has been well established that removal of the endothelium enhances responses to a variety of contractile agents in conductance arteries and that such modulation is predominantly due to the release of NO. The use of selective inhibitors of NO synthesis has confirmed that the endothelium-derived nitric oxide also modulates constriction in resistance vessels. 3. In a number of cardiovascular disease states there is impairment of endothelial function. Thus one of the consequences of atherosclerosis, hypertension and ischaemia is a reduction in endothelium-dependent vasodilatation, both at a basal level and in response to endogenous and exogenous stimuli. In addition, enhanced responses to vasoconstrictors have been reported in those disease states. Such observations have led to the attractive hypothesis that enhanced constriction in vascular disease results from attenuate NO-induced dilatation. However, whilst there is some evidence that pathological impairment of endothelial function is accompanied by increased constrictor activity, particularly where serotonergic mechanisms are involved, it is inappropriate to make the general assumption that where disease impairs NO activity there will also be increased sensitivity to all constrictor stimuli.
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Affiliation(s)
- O L Woodman
- Department of Pharmacology, University of Melbourne, Parkville, Victoria, Australia
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Otsuji S, Nakajima O, Waku S, Kojima S, Hosokawa H, Kinoshita I, Okubo T, Tamoto S, Takada K, Ishihara T. Attenuation of acetylcholine-induced vasoconstriction by L-arginine is related to the progression of atherosclerosis. Am Heart J 1995; 129:1094-100. [PMID: 7754938 DOI: 10.1016/0002-8703(95)90388-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To determine if L-arginine, a precursor of the endothelium-derived relaxing factor, restores endothelium-dependent dilation in human coronary arteries, we studied 21 patients in whom the lumina of the coronary arteries were angiographically smooth or slightly irregular and in whom there was a constrictor response to acetylcholine (ACh) in the left anterior descending coronary artery or the circumflex coronary artery. We examined the response to intracoronary ACh before and after infusion of L-arginine by measuring coronary diameter with quantitative angiography. Intracoronary injection of ACh produced vasoconstriction in the majority of patients with coronary risk factors. The percentage diameter change in smooth segments in patients with entirely smooth coronary arteries (group 1, n = 44) from baseline was -20.7% +/- 17.4%. During systemic infusion of L-arginine, the constrictor response to ACh in these segments was significantly attenuated (-2.2% +/- 15.1% from baseline, p < 0.01, ACh alone vs ACh during L-arginine infusion). In smooth segments in patients with luminal irregularities in the other coronary arteries (group 2, n = 19), ACh produced a marked constriction (-32.5% +/- 22.5% from baseline, p < 0.05, group 1 vs group 2). Infusion of L-arginine also attenuated ACh-induced vasoconstriction in these segments (-9.7% +/- 14.1% from baseline, p < 0.01, ACh vs ACh during L-arginine infusion). In segments with irregular lumina (group 3, n = 26), ACh produced more prominent vasoconstriction. The percentage diameter change was -40.9% +/- 26.5% from baseline (p < 0.01 vs group 1).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Otsuji
- Department of Internal Medicine I, Osaka Medical College, Japan
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Mc Fadden EP, Bauters C, Lablanche JM, Quandalle P, Leroy F, Bertrand ME. Response of human coronary arteries to serotonin after injury by coronary angioplasty. Circulation 1993; 88:2076-85. [PMID: 8222101 DOI: 10.1161/01.cir.88.5.2076] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Atherosclerotic stenoses that have exaggerated vasomotor responses are especially prone to restenosis after coronary angioplasty. Experimental studies show that vasomotor responses in normal vessels are altered by acute mechanical injury, an alteration that in part reflects changes in the functional characteristics of endothelium that has regenerated after injury. METHODS AND RESULTS We examined, by quantitative coronary arteriography, the response of dilated and control coronary segments to intracoronary infusions of graded doses of serotonin, an endothelium-dependent vasoactive agent, and to intracoronary injection of isosorbide dinitrate, an endothelium-independent smooth muscle dilator in 15 patients who had undergone a single percutaneous transluminal coronary angioplasty procedure and who had no clinical features of variant angina. Dose-dependent constriction to serotonin occurred at all measured sites. The mean +/- SEM diameter reductions, expressed as percent reduction in baseline diameter that was observed at proximal (18.1 +/- 2.9, 18.8 +/- 2.2) and distal (30.9 +/- 4.4, 35.4 +/- 5.3) control sites in the dilated and nondilated vessels, respectively, at the highest dose, were similar. The degree of constriction in distal segments was significantly (P < .01) greater than that in proximal segments. Total or subtotal occlusion occurred at the angioplasty site in 4 patients at the highest infused dose (10(-4) mol/L). The mean percent reduction in baseline diameter at previously dilated sites (53.8 +/- 5.9) at this dose was significantly (P < .05) greater than that observed at the adjacent proximal control sites and similar to that observed at distal control sites. All segments dilated significantly after intracoronary injection of isosorbide dinitrate. CONCLUSIONS In dilated and nondilated vessels, serotonin caused significantly more marked constriction in distal than in proximal vessel segments. In dilated vessels, the vessel segments that had been subjected to angioplasty had a constrictor response to serotonin that was more marked than at adjacent proximal control sites and equivalent to that in the distal vessel segments. This enhanced constrictor response could be related to changes in endothelial cell function after regeneration or to hyperreactivity of smooth muscle cells at the angioplasty site.
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Affiliation(s)
- E P Mc Fadden
- Service de Cardiologie B et Hémodynamique, Hôpital Cardiologique, Lille, France
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Cocks TM, Kemp BK, Pruneau D, Angus JA. Comparison of contractile responses to 5-hydroxytryptamine and sumatriptan in human isolated coronary artery: synergy with the thromboxane A2-receptor agonist, U46619. Br J Pharmacol 1993; 110:360-8. [PMID: 8220898 PMCID: PMC2176043 DOI: 10.1111/j.1476-5381.1993.tb13818.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
1. The interaction between the thromboxane A2 receptor agonist, U46619 and two 5-hydroxytryptamine (5-HT) receptor agonists, the non-selective, naturally occurring agonist, 5-HT and the selective 5-HT1-like agonist, sumatriptan were studied in human epicardial coronary arteries in vitro. 2. Coronary artery rings (2-4 mm in diameter) were prepared from epicardial arteries from explant hearts of patients undergoing heart transplant (cardiomyopathy, n = 13; ischaemic heart disease, n = 10) and unused donor hearts (n = 5). Each ring of artery was set at optimal resting conditions to record changes in isometric force. 3. The majority of artery rings developed phasic, rhythmic contractions either spontaneously or in response to all vasoconstrictor agonists tested. Both the spontaneous and agonist-induced phasic contractions were abolished by nifedipine (0.1 microM). 4. Concentration-contraction curves to 5-HT-receptor agonists and noradrenaline (NA), were first constructed in artery rings that did not develop phasic activity. 5-HT and ergometrine were the most potent agonists with EC50 values of 6.8 +/- 0.2 and 7.7 +/- 0.2 (-log M) respectively. Potencies (EC50's) to sumatriptan, methysergide and noradrenaline could not be determined due to their poor ability to contract the coronary artery. Maximum contractions (Emax; normalized as a percentage of the contraction to a maximum-depolarizing concentration of K+ in physiological salt solution (KPSS)) for 5-HT, ergometrine, sumatriptan, methysergide and noradrenaline were 40 +/- 10, 9 +/- 3, < 5, < 5 and < 5% respectively. 5. In arteries without phasic activity, U46619 (1 nM) caused an increase in force of 3.8 +/- 1% KPSS. With U46619 present, the Emax values for 5-HT, ergometrine, sumatriptan and methysergide were all markedly increased. For 5-HT and sumatriptan, E., values were 92+/- 4% and 49 +/- 14% KPSSrespectively. The presence of U46619 did not significantly change the sensitivity (EC50) to 5-HT.6. In a separate series of arteries, nifedipine (0.1 microM) was used to block phasic, contractile activity. The synergy observed between U46619 and 5-HT or sumatriptan still occurred although the Emax values for each agonist were depressed but the EC50 values were again unaffected.7. In conclusion, these in vitro studies indicate that the normally poor contractions to sumatriptan, inhuman coronary arteries are significantly enhanced when active force is induced with a thromboxane A2-receptor agonist, U46619. The enhanced response is not specific for either sumatriptan or 5-HT,-like receptors since contractions to 5-HT, ergometrine and methysergide were also potentiated by U46619.
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Affiliation(s)
- T M Cocks
- Baker Medical Research Institute, Melbourne, Victoria, Australia
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