Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Coronary response to diving in subjects with mild and severe left coronary artery disease
Istituto di Clinica Medica Generale and Cattedra di Semeiotica Medica, Università di Milano; Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore and Centro Auxologico Italiano Milano, Italy
Received 23 October 1990; revised 5 April 1991; .
Correspondence. Professor Giuseppe Mancia, Centro Fisiologia Clinica e Ipertensione, Via F. Sforza 35, 20122 Milano, Italy
Abstract
The cold pressor test (CPT) is commonly used to determine the vasospastic origin of angina and to investigate the factors modulating coronary vasomotor tone. However, coronary vasoconstriction associated with this manoeuvre is often limited, particularly in patients with mild coronary atherosclerosis. To identfy stimuli that can more powerfully constrict the coronary arteries we compared the effects on coronary blood flow (thermodilution) and vascular resistance (mean aortic pressure divided by coronary blood flow) of CPT (2 min) and diving (D, 45 s) in subjects with angiographically documented mild (n = 11) or severe (n = 11) left anterior descending coronary artery stenosis. In subjects with severe coronary artery stenosis the rate-pressure product increased to a similar extent with CPT and D. The latter stimulus, however, caused a more marked fall in coronary blood flow and a much more pronounced increase in coronary resistance as compared to CPT (+44±3.1% vs + 19±1.6%, P<0.01). In the face of a similar increase in rate-pressure product, D caused a significant increase in coronary vascular resistance also in patients with mild coronary artery stenosis ( 50%) in which CPT failed to induce any coronary vasoconstriction (+ 16 ± 1.8% vs + 0.3 ± 1.3%. P <0.01). Thus, diving is a much more powerful coronary vasoconstrictor stimulus than CPT. It can thus replace CPT when an increase in coronary resistance is needed for diagnostic purposes or for investigating abnormalities in coronary vascular regulation.
Key Words: Cold pressor test • diving test • coronary vascular reactivity • coronary heart disease
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