Compensatory enlargement of human atherosclerotic coronary arteries

Whether human coronary arteries undergo compensatory enlargement in the presence of coronary disease has not been clarified. We studied histologic sections of the left main coronary artery in 136 hearts obtained at autopsy to determine whether atherosclerotic human coronary arteries enlarge in relation to plaque (lesion) area and to assess whether such enlargement preserves the cross-sectional area of the lumen. The area circumscribed by the internal elastic lamina (internal elastic lamina area) was taken as a measure of the area of the arterial lumen if no plaque had been present. The internal elastic lamina area correlated directly with the area of the lesion (r = 0.44, P less than 0.001), suggesting that coronary arteries enlarge as lesion area increases. Regression analysis yielded the following equation: Internal elastic lamina area = 9.26 + 0.88 (lesion area) + 0.026 (age) + 0.005 (heart weight). The correlation coefficient for the lesion area was significant (P less than 0.001), whereas the correlation coefficients for age and heart weight were not. The lumen area did not decrease in relation to the percentage of stenosis (lesion area/internal elastic lamina area X 100) for values between zero and 40 percent but did diminish markedly and in close relation to the percentage of stenosis for values above 40 percent (r = -0.73, P less than 0.001). We conclude that human coronary arteries enlarge in relation to plaque area and that functionally important lumen stenosis may be delayed until the lesion occupies 40 percent of the internal elastic lamina area. The preservation of a nearly normal lumen cross-sectional area despite the presence of a large plaque should be taken into account in evaluating atherosclerotic disease with use of coronary angiography.     

Glycosaminoglycans in normal and atherosclerotic human coronary arteries

Glycosaminoglycans (GAGs) were studied in normal and atherosclerotic coronary arteries of 15- to 60-year-old Finnish men who had died accidentally. The GAGs were fractionated and quantified with electrophoretic techniques. The contents of sulfated GAGs (micrograms/cm2 vessel surface area) increased continuously until 20 to 30% of the vessel surface area was covered with fibrous plaques, after which they started to decrease. The largest increases were seen in chondroitin sulfates A and C and dermatan sulfate, the former of which rose earlier with lesion development. In normal coronary arteries the contents of dermatan sulfate and chondroitin sulfates A and C increased significantly with age, but the rises were much smaller than those found in affected vessels. The age-related changes in the percentage composition of GAGs in normal coronaries were qualitatively similar to those found in affected coronaries during lesion development. The alterations in arterial GAGs, therefore, seem to be related to two processes, both of which involve increased formation of connective tissue components by arterial smooth muscle cells: the normal growth and maturation of the vessels with a slow development of diffuse intimal thickening, and atherogenesis, which greatly increases the contents of sulfated GAGs in affected arteries.     

Microcalcifications in early intimal lesions of atherosclerotic human coronary arteries

Although calcium (Ca) precipitation may play a pathogenic role in atherosclerosis, information on temporal patterns of microcalcifications in human coronary arteries, their relation to expression of calcification-regulating proteins, and colocalization with iron (Fe) and zinc (Zn) is scarce. Human coronary arteries were analyzed post mortem with a proton microprobe for element concentrations and stained (immuno)histochemically for morphological and calcification-regulating proteins. Microcalcifications were occasionally observed in preatheroma type I atherosclerotic intimal lesions. Their abundance increased in type II, III, and IV lesions. Moreover, their appearance preceded increased expression of calcification-regulating proteins, such as osteocalcin and bone morphogenetic protein-2. In contrast, their presence coincided with increased expression of uncarboxylated matrix Gla protein (MGP), whereas the content of carboxylated MGP was increased in type III and IV lesions, indicating delayed posttranslational conversion of biologically inactive into active MGP. Ca/phosphorus ratios of the microcalcifications varied from 1.6 to 3.0, including amorphous Ca phosphates. Approximately 75% of microcalcifications colocalized with the accumulation of Fe and Zn. We conclude that Ca microprecipitation occurs in the early stages of atherosclerosis, inferring a pathogenic role in the sequel of events, resulting in overt atherosclerotic lesions. Microcalcifications may be caused by local events triggering the precipitation of Ca rather than by increased expression of calcification-regulating proteins. The high degree of colocalization with Fe and Zn suggests a mutual relationship between these trace elements and early deposition of Ca salts.     

Residual strain in human atherosclerotic coronary arteries and age related geometrical changes

The opening angles of 16 rings excised from human coronary arteries with different degrees of atherosclerosis were determined 10 hours after death. Atherosclerosis, as a chronic inflammatory response of arterial endothelium and intima, is defined by three degrees of its development. The opening angle decreases more or less linearly with the distance from the right coronary artery orifice. This is in accordance with the functional requirements posed on blood transport into the coronary arteries. A decrease of the opening angle with age is affected by hardening of the arterial wall, among other factors. This is in accordance with a stochastic model of age related changes in the initial modulus of elasticity of the coronary artery. A part of the free energy of smooth muscle cells, fibroblasts, collagen and elastic fibres is used not for creating residual strain but for remodeling the arterial wall structure. The opening angle is also considerably affected by the degree of atheroclerosis. The dependence on age of the external diameter and the thickness of the intact left and right coronary arteries in the vicinity of the aortic sinus was also analyzed in two female and two male subjects. To ensure the objectivity of the results it is necessary to carry out additional experiments and studies in vivo.     

Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries

Acetylcholine is believed to dilate normal blood vessels by promoting the release of a vasorelaxant substance from the endothelium (endothelium-derived relaxing factor). By contrast, if the endothelium is removed experimentally, acetylcholine constricts blood vessels. We tested the hypothesis that muscarinic cholinergic vasodilation is impaired in coronary atherosclerosis. Graded concentrations of acetylcholine and, for comparison, the nonendothelial-dependent vasodilator nitroglycerin were infused into the left anterior descending artery of eight patients with advanced coronary stenoses (greater than 50 percent narrowing), four subjects with angiographically normal coronary arteries, and six patients with mild coronary atherosclerosis (less than 20 percent narrowing). Vascular responses were evaluated by quantitative angiography. In several segments each of four normal coronary arteries, acetylcholine caused a dose-dependent dilation from a control diameter of 1.94 +/- 0.16 mm to 2.16 +/- 0.15 mm with the maximal acetylcholine dose (P less than 0.01). In contrast, all eight of the arteries with advanced stenoses showed dose-dependent constriction, from 1.05 +/- 0.05 to 0.32 +/- 0.16 mm at the highest concentration of acetylcholine (P less than 0.01), with temporary occlusion in five. Five of six vessels with minimal disease also constricted in response to acetylcholine. All vessels dilated in response to nitroglycerin, however. We conclude that paradoxical vasoconstriction induced by acetylcholine occurs early as well as late in the course of coronary atherosclerosis. Our preliminary findings suggest that the abnormal vascular response to acetylcholine may represent a defect in endothelial vasodilator function, and may be important in the pathogenesis of coronary vasospasm.     

Simultaneous electrical and mechanical recording in small isolated perfused arteries

A new method is described for simultaneous measurements of electrical and mechanical activity in an intact segment of a small artery (outside diameter 0·3–0·5 mm). A 7–9 mm segment of rabbit middle-cerebral artery was ligated on a Teflon tube connected to a perfusion circuit. The presence of a plug in the tube, flanked by two orifices, forced the physiological solution to flow in the annular space between the tube and the artery wall. Physiological pressures could thus be attained at low rates of flow, and the pressure, measured upstream, was significantly modifed by the slightest constriction or dilatation of the vascular segment. Electrical recording with glass microelectrodes was performed on a short immobilised portion of the artery. The artery and tube were bathed in a physiological solution at 38°C, but perfusing and incubating solutions did not mix. Spontaneous electrical and mechanical activity of middle cerebral arteries is described, together with modifications induced by vasoactive agents.     

Angiogenesis and lymphangiogenesis and expression of lymphangiogenic factors in the atherosclerotic intima of human coronary arteries

Little information regarding the development of lymphangiogenesis in coronary atherosclerosis is available. We immunohistochemically investigated the correlation among intimal neovascularization (CD34 for angiogenesis and lymphatic vessel endothelial hyaluronan receptor-1 [LYVE-1] and podoplanin for lymphangiogenesis), the expression of lymphangiogenic factors (vascular endothelial growth factor [VEGF]-C and VEGF-D), and the progression of atherosclerosis using 169 sections of human coronary arteries from 23 autopsy cases. The more the atherosclerosis advanced, the more often the neointimas contained newly formed blood vessels ( P < .0001). Vascular endothelial growth factor-C was expressed mostly in foamy macrophages and in some smooth muscle cells, whereas VEGF-D was abundantly expressed in both. The number of VEGF-C-expressing cells, but not that of VEGF-D-expressing cells, was increased as the lesion advanced and the number of intimal blood vessels increased ( P < .01). Lymphatic vessels were rare in the atherosclerotic intima (LYVE-1 vs CD34 = 13 vs 3955 vessels) compared with the number seen in the adventitia (LYVE-1 vs CD34 = 360 vs 6921 vessels). The current study suggests that VEGF-C, but not VEGF-D, may contribute to plaque progression and be a regulator for angiogenesis rather than lymphangiogenesis in coronary atherosclerotic intimas. Imbalance of angiogenesis and lymphangiogenesis may be a factor contributing to sustained inflammatory reaction during human coronary atherogenesis.     

Angiotensin-II stimulates nitric oxide release in isolated perfused renal resistance arteries

 Nitric oxide (NO) has been implicated as a modulator of the vascular effects of angiotensin II (ANG II) in the kidney. We used a NO-sensitive microelectrode to study the effect of ANG II on NO release, and to determine the effect of selective inhibition of the ANG II subtype I receptor (AT1) with losartan (LOS) and candesartan (CAN). NO release from isolated and perfused renal resistance arteries was measured with a porphyrin-electroplated, carbon fiber. The vessels were microdissected from isolated perfused rat kidneys and perfused at constant flow and pressure in vitro. The NO-electrode was placed inside the glass collection cannula to measure vessel effluent NO concentration. ANG II stimulated NO release in a dose-dependent fashion: 0.1 nM, 10 nM and 1000 nM ANG II increased NO-oxidation current by 85±18 pA (n = 11), 148±22 pA (n = 11), and 193±29 pA (n = 11), respectively. These currents correspond to changes in effluent NO concentration of 3.4±0.5 nM, 6.1±1.1 nM, and 8.2±1.3 nM, respectively. Neither LOS (1 μM) nor CAN (1 nM) significantly affected basal NO production, but both AT1-receptor blockers markedly blunted NO release in response to ANG II (10 nM): 77±6% inhibition with LOS (n = 8) and 63±9% with CAN (n = 8). These results are the first to demonstrate that ANG II stimulates NO release in isolated renal resistance arteries, and that ANG II-induced NO release is blunted by simultaneous AT1-receptor blockade. Our findings suggest that endothelium-dependent modulation of ANG II-induced vasoconstriction in renal resistance arteries is mediated, at least in part, by AT1-receptor-dependent NO release. Received: 24 September 1997 / Accepted: 20 October 1997     

Effect of magnetic field on haemodynamic perturbations in atherosclerotic coronary arteries

Haemodynamic perturbations including elevated blood viscosity, low and oscillatory shear stress are understood to be important pathogenic mediators in atherosclerosis. These haemodynamic abnormalities are influenced by the presence of a magnetic field. This study conducted computational fluid dynamics (CFD) analysis in 4 coronary artery models, derived from authentic human coronaries, with mild and moderate and severe stenosis severity. The aim was to investigate the effect of a static magnetic field of varying intensities on blood viscosity, areas of low wall shear stress (ALWSS), maximum wall shear stress (MWSS) and length and volume of flow recirculation zones. The results showed that the magnetic field results in both beneficial and detrimental changes in haemodynamics. The beneficial effects are lowered viscosity, decreased size of ALWSS and flow recirculation zones whereas the detrimental effect is increased MWSS. With increasing stenosis severity the effect of magnetic field becomes more prominent. An externally applied magnetic field can improve haemodynamics perturbations in human coronary arteries, especially in the setting of moderate-to-severe stenosis severity.     

Angiogenesis in human coronary atherosclerotic plaques.

Neovascularization in the walls of coronary arteries is associated with the presence of atherosclerotic plaque. The mechanisms responsible for the formation of these intraplaque microvessels are not understood. The purpose of this study is to examine the prevalence of endothelial cell replication in plaque microvessels. Two hundred and one primary and restenotic coronary atherectomy specimens were analyzed for the presence of microvessels and proliferation as reflected by positive immunolabeling for Ulex agglutinin and the proliferating cell nuclear antigen, respectively. In primary but not restenotic specimens, proliferation of any cell type was associated with the detection of microvessels on the same slide. However, intraplaque microvessels were more commonly found in restenotic compared to primary specimens (P = 0.004). Twelve highly vascularized specimens with evidence of replication were subjected to detailed histomorphological and quantitative image analyses. At 200 x, the most vascular optical field of each slide was identified and consistently included plaque macrophages. Total slide endothelial cell replication indices for these specimens varied, but in some instances were remarkably elevated (eg, 43.5%). The role of intraplaque angiogenesis may be analogous to that of tumor or wound angiogenesis and be important in development and progression of coronary artery lesions and restenosis.     

Segmentation of high-frequency ultrasound images of atherosclerotic coronary arteries.

High-frequency epicardial echocardiography (HFE) is an ultrasound imaging technique capable of visualizing coronary arteries in cross-section. Use of this imaging technique in the intra-operative setting can provide information about the structure of coronary arteries. As a result of time constraints imposed in this setting, there is a need for rapid, on-line analysis of HFE images. An algorithm for segmenting HFE images of coronary arteries into wall and luminal regions is described in this paper. The algorithm is more objective and time efficient than manual methods. A validation study with post-mortem human hearts demonstrated an excellent correlation (r = 0.99 for luminal areas, r = 0.99 for wall areas) between HFE images segmented with the algorithm and by manual methods, and a good correlation (r = 0.90 for luminal areas, r = 0.86 for wall areas) between HFE images segmented with the algorithm and manually segmented images of histological samples of the corresponding coronary arterial segments. Use of the algorithm for intra-operative HFE image segmentation may reduce the amount of time required for HFE image analysis and allow for an increased amount of data collection and analysis in the operating room.     

Influence of mannitol on contractile responses of isolated perfused arteries.

The influence of hyperosmotic mannitol on vascular smooth muscle contractile responses was examined in isolated arterial preparations. Vasoconstrictor effects of norepinephrine (NE) and potassium chloride (K+) in the perfused central artery of the rabbit's ear and in perfused mesenteric arteries of cats were significantly inhibited by infusion with Krebs bicarbonate solution made hyperosmotic with mannitol (50-200 mosM increase). Similarly, the magnitude and duration of vasoconstrictor responses to transmural stimulation of the central ear artery of the rabbit were decreased by hyperosmotic mannitol (50 mosM). Mannitol (50 mosM) produced a decrease in perfusion pressure when perfusion pressure was maintained at an increased level by K+ (60 mM). Mannitol-induced vasodilatation was not affected by ethacrynic acid (1.5 X 10(-5) M), beta adrenergic blockade or by the development of tachyphylaxis to the vasodilator effects of nitroglycerin. The concentration of cyclic adenosine-monophosphate was not changed by mannitol. Isotonic mannitol also inhibited NE-induced contractile responses. These data indicate that hyperosmotic mannitol produces vasodilatation in isolated arterial smooth muscle by a mechanism(s) that appears dissimilar from that of several other vasodilator substances and suggest that hypertonicity may not be the only factor involved in the vasodilator effect of mannitol.     

Vasomotor changes in isolated coronary arteries from diabetic rats

Contractile responses to prostaglandin F2 alpha, serotonin, noradrenaline, and potassium were examined in isolated intramyocardial arteries of Wistar rats 8 weeks after the induction of diabetes mellitus by administration of streptozotocin (STZ). The concentration-response curves obtained were compared with those noted in vessels both from age- and from weight-matched control rats. Light and electron microscopy did not reveal any major change in coronary artery wall thickness or morphology. There was no difference in the pattern of vasomotor responses between the two control groups. Contractile responses to prostaglandin F2 alpha, and potassium were significantly reduced, while contractile responses to serotonin and noradrenaline were unaltered in coronary arteries from diabetic rats. The vasomotor responses to noradrenaline and potassium showed a biphasic pattern in control vessels, i.e. contraction noted at high agonist concentrations was preceded by slight, but reproducible relaxation at lower concentrations. In diabetic vessels these relaxant responses were absent. The contraction produced by noradrenaline was markedly enhanced by the presence of propranolol in both diabetic and control vessels. Dilator responses to verapamil, diltiazem, nifedipine, papaverine and magnesium were studied in serotonin-precontracted coronary arteries; the concentration-response curves obtained by verapamil and diltiazem were shifted to the right in diabetic vessels. It appears justified to use vessels from age-matched rats as controls when vasomotor reactivity in coronary arteries from STZ-diabetic rats is investigated. The reduction in contractile responses to prostaglandin F2 alpha and potassium, and the reduction or lack of relaxant responses to noradrenaline, potassium, verapamil and diltiazem, in diabetic coronary arteries, indicate a selective modification of the coronary circulation by the diabetic disease.     

Localization of apolipoprotein A-I and apolipoprotein A-II in human atherosclerotic arteries

Apolipoprotein A-I and apolipoprotein A-II, the two major protein components of the high-density lipoproteins, were visualized in human arteries using an immunofluorescence technique. Apolipoprotein A-I and apolipoprotein A-II were codeposited into the intima and upper media of normal arteries of atherosclerotic patients. The amount of deposits increased in fatty streaks. In atherosclerotic plaques, apolipoproteins accumulated around the necrotic material. These two apoproteins were present in the extracellular matrix as well as in the foam cells surrounding the atherosclerotic lesions. The concomitant intracellular localization of apolipoprotein A-I and of apolipoprotein A-II in the cytoplasm of foam cells supports the hypothesis that extracellular high-density lipoprotein particles are internalized in the macrophages during the atheromatous process.     

Collagen fiber pathology in atherosclerotic plaques of the coronary arteries in ischemic heart disease

Structure-metabolic changes of collagen fibers (CF) in atherosclerosis plaques of the coronary arteries in the conditions of ischemic heart disease (IHD) have been studied. Segments of the coronary arteries were received from 68 men after a coronary artery bypass grafting. CF was study with using of the Van Gieson's and the Masson's methods. Histologic slices were studied by polarization microscopy. The atherosclerosis plaques with IHD were notable for lipidosis of CF. We've suspected lipidosis of CF is a crucial factor for the development of atherosclerosis plaques instability. Evident lipidosis of CF was attended with destructive changes probably resulted in accumulation of atheromatous mass in atherosclerosis plaques.     

Vasculature in the walls of human coronary arteries

Casts were produced of the arterial networks of 25 human hearts obtained at autopsy from subjects who were not diagnosed as having cardiovascular disease. Many casts showed imprints of atherosclerotic plaques, remnants of calcified masses, and fine vascular meshes near the lumen of the major coronary arteries. Of 25 casts produced, 14 contained one or more of these anomalies, seven contained vascular meshes, and five of these related to imprints and/or calcified masses. Analysis of these findings in the context of atherosclerosis, intramural hemorrhage, and vascular spasm, suggests possible relationships between them. The findings support the hypothesis that neovasculature in the walls of coronary arteries may play a role in the pathogenesis of vascular disease and malfunction.