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European Heart Journal 1997 18(4):608-613;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Effects of inhibition of nitric oxide synthesis in patients with coronary artery disease and stable angina

D. Tousoulis, G. J. Davies, C. Tentolouris, T. Crake, D. C. Lefroy and P. Toutouzas

Cardiology Units, Hippokration Hospital, Athens University Medical School, Hammersmith Hospital London, U.K.

revised 25 June 1996; accepted 2 July 1996.

Correspondence: Dimitris Tousoulis MD, Cardiology Unit, Hammersmith Hospital, Du Cane Road, London W12 0NN, U.K.

Abstract

AIMS: Inhibition of nitric oxide synthesis causes a decrease in the basal diameter of normal distal epicardal coronary arteries in normal subjects. The effects of inhibition of nitric oxide in atheromatous coronary arteries is unknown. This study assessed the effects of the inhibition of nitric oxide synthesis in epicardial coronary arteries in patients with coronary artery disease.

METHODS AND RESULTS: The effects of an intracoronary infusion of NG-monomethyl-L-arginine (LNMMA, an inhibitor of nitric oxide synthesis), were studied in 13 patients with chronic stable angina and coronary artery disease. The diameter of angiographically normal proximal and distal segments and coronary stenoses was measured by quantitative angiography. In response to an LNMMA infusion of 16 µmol min–1 for 4 min there was a significant reduction (P<0·01) in the luminal diameter of the distal segments of diseased arteries (from 1·32 ± 0·07 to 1·17 ± 0·06 mm) and at the site of stenosis (from 1·15 ± 0·22 to 1·06 ± 0·20 mm), but no change (P=NS) in the luminal diameter of the proximal segments (from 3·16 ± 0·12 to 3·08 ± 0·14 mm) of diseased arteries.

CONCLUSIONS: The average effect of inhibition of basal nitric oxide synthesis in epicardial coronary arteries in patients with stable angina and coronary artery disease was only distal constriction. Coronary stenoses constricted at the highest LNMMA concentration.

Key Words: Endothelium • nitric oxide • coronary artery disease • endothelium-derived relaxing factor


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