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European Heart Journal 1989 10(Supplement G):58-63; doi:10.1093/eurheartj/10.suppl_G.58
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Coronary stenosis vasomotion during dynamic exercise before and after PTCA*

T. M. Suter, O. M. Hess, A. Bortone, H. Nonogi, J. Grimm and H. P. Krayenbuehl

Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital Zürich, Switzerland

Address for correspondence: Otto M. Hess, M.D., Medical Policlinic, Cardiology, University Hospital Raemistrasse 100, CH-8091 Zürich, Switzerland

Coronary vasomotion was evaluated in eight patients (age 50 ± 8 years) with coronary disease before and 3·3 ± 1·9 months after successful percutaneous transluminal coronary angioplasly (PTCA). Luminal area of a normal and a stenotic coronary artery was determined before and after PTCA using biplane quantitative coronary arteriography. Patients were studied at rest, during supine bicycle exercise and 5 mm after 1·6 mg sublingual nitroglycerin. Workloads before and after PTCA were identical.

Percentage diameter stenosis decreased from 78% to 24% (P < 0·001) after PTCA. Mean pulmonary artery pressure increased during exercise from 21 to 40 mmHg (P < 0·001) before and from 19 to 34 mmHg (P < 0·001) after PTCA. Peak exercise pulmonary artery mean pressure was significantly (P < 0·05) lower after PTCA. Normal coronary arteries showed a minimal increase in mean luminal area before (+2%; NS) as well as after (+ 6%; NS) PTCA. Nitroglycerin produced dilation of the normal vessel segment to a similar extent pre- (+27%; P < 0·001) and post- (+31%; P < 0·001) PTCA. In contrast, stenotic vessel segments showed coronary vasoconstriction during exercise before PTCA (–28%; P < 0·01); after PTCA, exercise-induced vasoconstriction of the diseased segment was minimal (–4%; NS). Nitroglycerin was associated with vasodi lation of the stenotic vessel segment before (+17%; NS) as well as after (+26%; P <0·005) PTCA.

Thus, exercise-induced coronary vasoconstriction of stenotic coronary arteries is observed before as well as after PTCA, but vasoconstriction after PTCA is significantly less than before PTCA. Coronary vasomotion appears to be modified in a positive way by PTCA, but the exact mechanism remains unclear.

Key Words: Coronary artery disease • coronary vasomotion, percutaneous transluminal coronary angioplasty • supine bicycle exercise

* This work was supported by a grant of the Swiss National Science Foundation.


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