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J Clin Invest. 1989 June; 83(6): 1946–1952.
PMCID: PMC303917

Atherosclerosis influences the vasomotor response of epicardial coronary arteries to exercise.


We studied the vasomotion of epicardial coronary arteries during exercise and tested the hypotheses that abnormal vasoconstriction is related to the presence of atherosclerosis and may be related to endothelial dilator dysfunction. During cardiac catheterization quantitative coronary angiography was performed in 21 patients during supine bicycle exercise. 21 of 28 smooth, angiographically normal vessel segments dilated (14.0 +/- 1.8%) during exercise; four smooth segments did not change whereas only three constricted. In contrast, 15 of 16 vessel segments with irregularities constricted in response to exercise (17.0 +/- 0.1%) with only one segment dilating. All 10 stenotic segments constricted to exercise (23 +/- 4%). Six patients also received intracoronary acetylcholine before exercise to test endothelium-dependent dilator function. In five of six patients all nine vessel segments showed the same directional response to acetylcholine and exercise. Three irregular and two stenotic segments constricted with acetylcholine (51 +/- 21%) and exercise (9.0 +/- 0.6%). In contrast, four smooth segments dilated to acetylcholine (19 +/- 6%) and exercise (9 +/- 1%). Both exercise and acetylcholine generally dilated smooth but constricted irregular and stenosed coronary segments. It appears likely that atherosclerosis plays an important role in the abnormal vasomotion of diseased coronary arteries during exercise and the pattern of abnormality suggests impairment of vasodilator function.

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Selected References

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  • Brown BG, Bolson EL, Dodge HT. Dynamic mechanisms in human coronary stenosis. Circulation. 1984 Dec;70(6):917–922. [PubMed]
  • Deanfield JE, Shea M, Ribiero P, de Landsheere CM, Wilson RA, Horlock P, Selwyn AP. Transient ST-segment depression as a marker of myocardial ischemia during daily life. Am J Cardiol. 1984 Dec 1;54(10):1195–1200. [PubMed]
  • Fish RD, Nabel EG, Selwyn AP, Ludmer PL, Mudge GH, Kirshenbaum JM, Schoen FJ, Alexander RW, Ganz P. Responses of coronary arteries of cardiac transplant patients to acetylcholine. J Clin Invest. 1988 Jan;81(1):21–31. [PMC free article] [PubMed]
  • Ludmer PL, Selwyn AP, Shook TL, Wayne RR, Mudge GH, Alexander RW, Ganz P. Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med. 1986 Oct 23;315(17):1046–1051. [PubMed]
  • Nabel EG, Ganz P, Gordon JB, Alexander RW, Selwyn AP. Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressor test. Circulation. 1988 Jan;77(1):43–52. [PubMed]
  • Peuler JD, Johnson GA. Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine and dopamine. Life Sci. 1977 Sep 1;21(5):625–636. [PubMed]
  • Ganz W, Tamura K, Marcus HS, Donoso R, Yoshida S, Swan HJ. Measurement of coronary sinus blood flow by continuous thermodilution in man. Circulation. 1971 Aug;44(2):181–195. [PubMed]
  • Spears JR, Sandor T, Als AV, Malagold M, Markis JE, Grossman W, Serur JR, Paulin S. Computerized image analysis for quantitative measurement of vessel diameter from cineangiograms. Circulation. 1983 Aug;68(2):453–461. [PubMed]
  • Gage JE, Hess OM, Murakami T, Ritter M, Grimm J, Krayenbuehl HP. Vasoconstriction of stenotic coronary arteries during dynamic exercise in patients with classic angina pectoris: reversibility by nitroglycerin. Circulation. 1986 May;73(5):865–876. [PubMed]
  • Vatner SF, Hintze TH, Macho P. Regulation of large coronary arteries by beta-adrenergic mechanisms in the conscious dog. Circ Res. 1982 Jul;51(1):56–66. [PubMed]
  • Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980 Nov 27;288(5789):373–376. [PubMed]
  • Furchgott RF. Role of endothelium in responses of vascular smooth muscle. Circ Res. 1983 Nov;53(5):557–573. [PubMed]
  • Freiman PC, Mitchell GG, Heistad DD, Armstrong ML, Harrison DG. Atherosclerosis impairs endothelium-dependent vascular relaxation to acetylcholine and thrombin in primates. Circ Res. 1986 Jun;58(6):783–789. [PubMed]
  • Cocks TM, Angus JA. Endothelium-dependent relaxation of coronary arteries by noradrenaline and serotonin. Nature. 1983 Oct 13;305(5935):627–630. [PubMed]
  • Pohl U, Holtz J, Busse R, Bassenge E. Crucial role of endothelium in the vasodilator response to increased flow in vivo. Hypertension. 1986 Jan;8(1):37–44. [PubMed]
  • Busse R, Trogisch G, Bassenge E. The role of endothelium in the control of vascular tone. Basic Res Cardiol. 1985 Sep-Oct;80(5):475–490. [PubMed]
  • Horio Y, Yasue H, Rokutanda M, Nakamura N, Ogawa H, Takaoka K, Matsuyama K, Kimura T. Effects of intracoronary injection of acetylcholine on coronary arterial diameter. Am J Cardiol. 1986 Apr 15;57(11):984–989. [PubMed]
  • Förstermann U, Mügge A, Frölich JC. Endothelium-dependent relaxation of human epicardial coronary arteries: frequent lack of effect of acetylcholine. Eur J Pharmacol. 1986 Sep 9;128(3):277–281. [PubMed]
  • Hintze TH, Vatner SF. Reactive dilation of large coronary arteries in conscious dogs. Circ Res. 1984 Jan;54(1):50–57. [PubMed]
  • Holtz J, Förstermann U, Pohl U, Giesler M, Bassenge E. Flow-dependent, endothelium-mediated dilation of epicardial coronary arteries in conscious dogs: effects of cyclooxygenase inhibition. J Cardiovasc Pharmacol. 1984 Nov-Dec;6(6):1161–1169. [PubMed]
  • Bossaller C, Habib GB, Yamamoto H, Williams C, Wells S, Henry PD. Impaired muscarinic endothelium-dependent relaxation and cyclic guanosine 5'-monophosphate formation in atherosclerotic human coronary artery and rabbit aorta. J Clin Invest. 1987 Jan;79(1):170–174. [PMC free article] [PubMed]
  • Klein LW, Segal BL, Helfant RH. Dynamic coronary stenosis behavior in classic angina pectoris: active process or passive response? J Am Coll Cardiol. 1987 Aug;10(2):311–313. [PubMed]
  • Heistad DD, Armstrong ML, Marcus ML, Piegors DJ, Mark AL. Augmented responses to vasoconstrictor stimuli in hypercholesterolemic and atherosclerotic monkeys. Circ Res. 1984 Jun;54(6):711–718. [PubMed]
  • Shimokawa H, Tomoike H, Nabeyama S, Yamamoto H, Araki H, Nakamura M, Ishii Y, Tanaka K. Coronary artery spasm induced in atherosclerotic miniature swine. Science. 1983 Aug 5;221(4610):560–562. [PubMed]
  • Schroeder JS, Bolen JL, Quint RA, Clark DA, Hayden WG, Higgins CB, Wexler L. Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography. Am J Cardiol. 1977 Oct;40(4):487–491. [PubMed]

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