Myocardial steal produced by coronary vasodilation in chronic coronary artery occlusion

Summary Chronic occlusion of the circumflex branch of the left coronary artery was produced in dogs. All animals developed a collateral circulation fast and efficient enough to prevent myocardial infarction. Tracer microsphere experiments together with 133-Xenon studies showed a homogeneous distribution of flow over the entire left ventricle. Drug-induced coronary vasodilation caused a grossly non-homogenous distribution of coronary blood flow. The collateral dependent areas of the heart received much less blood than the areas which are supplied by normal arterial channels. Within the collateral-dependent area the endocardial myocardium received less blood than the epicardial layers. Previously well perfused areas can become underperfused during overperfusion of normal myocardium. Similar changes were not observed in hearts with normal coronary arteries.Nitroclycerine did not produce changes in blood flow in hearts with coronary artery occlusion. Consequently changes in the distribution of myocardial flow were not observed with this drug. A computer model is presented for the explanation of the experimental findings which facilitated the analysis of contributing factors.

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Zusammenfassung Bei Hunden wurde ein chronischer Verschluß des ramus circumflexes der linken Koronararterie erzeugt. Bei allen Tieren entwickelte sich ein Kollateralkreislauf, der das Auftreten von Infarkten verhinderte. Die Durchblutung des linken Ventrikels bei chronischem Koronarverschluß war normal und die Durchblutungsverteilung war homogen, wie aus der 133-Xenon clearance zusammen mit der Gewebekonzentration von Tracer Microspheren hervorging. Pharmakologisch induzierte Koronardilation verursachte eine ungleichmäßige Durchblutungsverteilung. Das von Kollateralen abhängige Perfusionsgebiet erhielt bedeutend weniger Blut als der Teil des Myokards, der über normale Koronararterien versorgt wird. Innerhalb des kollateralabhängigen Myokards erhielt das subendokardiale Gebiet bedeutend weniger Blut pro Zeiteinheit als das subepikardiale Gebiet. Zonen, die vor der Dilation normal und homogen durchblutet waren, erhielten während der Dilatation weniger Blut. Derartige Verteilungsänderungen wurden nicht beobachtet bei Herzen mit normalen Koronararterien.Nitroglycerin verursachte keine Umverteilung der Durchblutung bei Herzen mit chronischem Koronarverschluß. Nitroglycerin verursachte allerdings auch keine nennenswerte Koronardilatation. Ein Komputermodell wird beschrieben zum besseren Verständnis der haemodynamischen Zusammenhänge bei Koronardilatation.

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With 5 figures and 7 tables     

Mechanism and modification of bradykinin-induced coronary vasodilation.

In isolated perfused rabbit hearts, bradykinin produced a concentration-dependent decrease in coronary resistance directly associated with biosynthesis and release of prostaglandin-E-like substance. An inhibitor of bradykinin destruction (the nonapeptide SQ-20881) markedly enhanced both the coronary vasodilation and release of prostaglandin-E-like substance produced by cardiac injection of bradykinin. Indomethacin inhibited both the myocardial prostaglandin biosynthesis and the decrease in coronary resistance induced by bradykinin. The demonstration that bradykinin is a potent stimulator of prostaglandin biosynthesis in the heart has implications as to the cause of the afferent cardiovascular reflexes and pain in myocardial infarction and angina pectoris.     

Reflex vasodilation induced by coronary angiography in human subjects.

In order to evaluate the reflex peripheral vascular effects of coronary arteriography, forearm blood flow was measured plethysmographically and forearm vascular resistance calculated before and during coronary angiography with Hypaque-M, 75%, and Renografin-76. The injection of Hypaque into the left coronary artery resulted in a forearm vasodilation which could not be duplicated by an injection of a comparable amount of contrast into the ascending aorta, three centimeters above the coronary ostia. Forearm blood flow rose from 2.95 to 5.41 ml/min/100 ml (83.4%) and forearm vascular resistance fell from 35.8 to 19.9 mm Hg/ml/min/100 ml (44.4%). Renografin injected into the left coronary artery resulted in less forearm vasodilation (21% increase in forearm blood flow and 32% decrease in forearm vascular resistance). When coronary arteriography was repeated following injection of atropine into the brachial artery, no forearm vasodilation occurred. It is suggested that in human subjects myocardial or coronary artery receptors can be activated by the intracoronary injection of iodinated contrast media which results in a forearm vasodilation.     

Effect of contrast media on coronary vascular resistance: contrast-induced coronary vasodilation.

STUDY OBJECTIVES: To determine if the vasodilatory response to the intracoronary injection of ionic and nonionic contrast media in intact pigs is dependent on nitric oxide (NO). The mechanisms responsible for inducing the increase in coronary blood flow in response to the intracoronary injection of contrast media during angiography are still not entirely understood. There is evidence to suggest that the response could be partially mediated by NO. PARTICIPANTS: We studied 14 anesthetized, open-chested pigs receiving ventilation. MEASUREMENTS AND RESULTS: Changes in coronary blood flow and coronary vascular resistance were measured in response to the coronary artery injection of saline solution (0.5 mol/L, isosmolar with plasma) and three different contrast agents: meglumine sodium ioxaglate (Hexabrix; Mallinckrodt Medical; Point-Claire, Quebec, Canada), a low osmolar ionic contrast agent; iohexol (Omnipaque 300; Sanofi Winthrop; Markham, Ontario, Canada), a nonionic contrast agent; and diatrizoate meglumine 66%, diatrizoate sodium 10% (MD-76; Mallinckrodt Medical), an ionic contrast agent. Measurements were made during three experimental conditions: the coronary artery infusion of (1) saline solution, control; (2) L-nitro-arginine (LNNA; 10(-3) mol/L and 10(-2) mol/L), a competitive inhibitor of NO synthase; and (3)L-arginine 10(-1) mol/L, a substrate for NO synthase. The infusion of LNNA produced an increase in baseline coronary vascular resistance (p < 0.001), but it did not attenuate the vasodilatory response to the infusion of the contrast agents. Both the high and low osmolar ionic and nonionic contrast media caused a decrease in baseline coronary vascular resistance. For all three conditions, MD-76, which has the highest osmolality, produced the greatest decrease in coronary vascular resistance. CONCLUSION: The vasodilatory response of the coronary vasculature to contrast agents is directly related to osmolality and is not mediated by NO.     

Selective vasodilation produced by renal denervation in adult spontaneously hypertensive rats

The kidneys of adult male spontaneously hypertensive rats (SHR) were denervated, and systemic and regional blood flows were measured 3 to 5 hours or 5 days after denervation. Arterial pressure was reduced 20 to 27% in denervated SHR during both periods compared with that in sham-operated SHR (iliolumbar blood vessels painted with phenol). This hypotensive response was produced by a 32 to 35% reduction in total peripheral resistance. At 3 to 5 hours and at 5 days, a major decrease in total peripheral resistance was produced by vasodilation in the kidneys and splanchnic organs. Acute urine output, sodium excretion, and plasma renin activity in response to a saline load were not different between sham-operated and denervated SHR. The decreased total peripheral resistance in denervated SHR may have been secondary to a decreased central sympathetic nerve activity revealed by a decreased maximum response to ganglionic blockade. The results suggest that a pathophysiological link may exist between the kidneys and splanchnic organs in genetic hypertension and that specific efferent antiadrenergic or antiafferent nerve therapy, or both, in the kidney may lead to substantial specific decreases not only in renal vascular resistance but also in splanchnic vascular resistance and total peripheral resistance.     

Redox-sensitive impairment of porcine coronary artery vasodilation by hypochlorite-modified LDL

Atherosclerotic vascular disease is associated with abnormal vasomotor function and oxidized low density lipoproteins (OxLDL) are believed to play a keyrole therein. Several compounds emerging from LDL lipid peroxidation have been shown to be able to alter vasomotion but the role of oxidized apoB in this process is not fully understood.

Myeloperoxidase has been identified in atherosclerotic lesions and hypochlorite produced by this enzyme represents a strong oxidant. LDL oxidation by hypochlorite differs from most other forms of LDL oxidation in that hypochlorite-mediated oxidation shows a predilection for the protein moiety of LDL and does not result in lipid peroxidation.

In this work, we use porcine coronary artery segments and show that hypochlorite-oxidized LDL (hyp-OxLDL) are able to impair dilatation induced by substance P in a dose- and modification-dependent way. Treatment of hyp-OxLDL with methionine resulted in quantitative elimination of reactive chloramines in LDL and complete recovery of relaxation. As application of the scavenger receptor antagonist maleylated albumin strongly interferes with the effects of hyp-OxLDL on vasomotion, we conclude that specific binding of hypochlorite-modified apoB is likely to be involved in mediating the observed effects.     

Mechanism of Ca++ antagonist-induced vasodilation. Intracellular actions

We studied the effects of Ca++ antagonists on intact and skinned muscles of rabbit mesenteric artery. Intact muscle contractions were inhibited by 10(-6) M diltiazem, whereas greater levels were required to abolish contractions in skinned muscle fibers. In contrast, nisoldipine had no effect on skinned muscle contractions, although it inhibited, almost completely, the contraction of intact muscle at concentrations below 10(-6) M. In the presence of EGTA, norepinephrine-induced contractions result from a release of Ca++ from an intracellular store. Diltiazem inhibited these contractions at concentrations between 10(-6) and 10(-4) M. Higher doses were required in studies with skinned muscle preparations. Unlike diltiazem, nisoldipine only partially inhibited the Ca++-free norepinephrine-induced contractions in the range of 10(-7) to 10(-5) M. From these results, we assumed that at low concentrations (below 10(-6) M), diltiazem induced relaxation by blocking Ca++ influx, whereas at relatively high concentrations (above 10(-6) M), an inhibition of Ca++ release from an intracellular store also occurred. A similar conclusion was reached regarding the mechanism whereby nisoldipine inhibits force developments.     

Comparison of coronary vasodilation with intravenous dipyridamole and adenosine.

Although both intravenous dipyridamole and adenosine have been used to produce coronary vasodilation during cardiac imaging, the relative potency of the commonly administered doses of these agents has not been evaluated. Accordingly, the coronary and systemic hemodynamic effects of intravenous adenosine (140 micrograms/kg per min) and intravenous dipyridamole (0.56 mg/kg over 4 min) were compared with a maximally dilating dose of intracoronary papaverine in 15 patients. Coronary blood flow responses were assessed using a Doppler catheter in a nonstenotic coronary artery. The protocol was discontinued in two patients because of transient asymptomatic atrioventricular (AV) block during adenosine infusion. The mean heart rate increased more with adenosine (11 +/- 9 beats/min) and dipyridamole (11 +/- 7 beats/min) than with papaverine (4 +/- 3 beats/min, p less than 0.05 vs. adenosine and papaverine). The mean arterial pressure decreased less with dipyridamole (-10 +/- 3 mm Hg) and papaverine (-9 +/- 4 mm Hg) than with adenosine (-16 +/- 5 mm Hg, p less than 0.01 vs. dipyridamole and papaverine). The peak/rest coronary blood flow velocity ratio was greater with papaverine (3.9 +/- 1.1) than with adenosine (3.4 +/- 1.2, p less than or equal to 0.05 vs. papaverine) or dipyridamole (3.1 +/- 1.2, p less than 0.01 vs. papaverine). A larger decrease in coronary resistance as measured by the coronary vascular resistance index occurred with papaverine (0.25 +/- 0.06) and adenosine (0.26 +/- 0.09) than with dipyridamole (0.31 +/- 0.10, p less than 0.01 vs. papaverine, p less than 0.05 vs. adenosine).(ABSTRACT TRUNCATED AT 250 WORDS)     

Leptin causes nitric-oxide independent coronary artery vasodilation in humans.

Recent studies have shown that leptin causes vasodilation. However, it is unclear whether leptin causes coronary vasodilation in humans. To determine how leptin affects human coronary arteries and whether endothelium-derived nitric oxide (EDNO) is involved in the coronary arterial response to leptin, we infused leptin (0.3, 3 and 30 ng/kg/min) for 2 min into the left coronary ostium before and after an infusion of nitric oxide synthase inhibitor, N(G)-monomethyl-L-arginine (L-NMMA), in 11 men with angiographically normal coronary arteries. The diameter of the epicardial coronary arteries was quantitatively measured, and coronary blood flow (CBF) was calculated by quantitative angiography and Doppler flow velocity measurements. The changes in these parameters in response to leptin are expressed as the % change from the baseline values. Leptin caused coronary dilation (0.3 ng/kg/min: 2.0+/-0.5%; 3 ng/kg/min: 4.9+/-0.7%; 30 ng/kg/min: 3.8+/-0.9%) and increased CBF (13.6+/-3.3%, 36.8+/-5.6%, and 39.2+/-7.4%, respectively). After the infusion of L-NMMA, leptin also caused coronary dilation (2.0+/-0.4%, 4.5+/-0.7%, and 4.6+/-0.8%, respectively) and increased CBF (14.6+/-2.8%, 39.2+/-5.7%, 40.3+/-6.2%, respectively). Leptin-induced coronary vasodilation was not affected by the infusion of L-NMMA. These results suggest that leptin dilates coronary arteries in humans. Furthermore, EDNO may not contribute to leptin-induced coronary dilation.     

Impaired endothelium-dependent cholinergic coronary vasodilation in patients with angina and normal coronary arteriograms.

The coronary vasomotor responses to selective infusion of graded concentrations (10(-6) to 10(-4) M) of acetylcholine into the left anterior descending artery were assessed by quantitative coronary arteriography in 24 patients with normal coronary arteriograms (12 patients with atypical symptoms and 12 patients with typical anginal pain) and 36 patients with coronary artery disease with different degrees of atherosclerosis of the left anterior descending artery. In the patients with normal coronary arteries and atypical chest pain, acetylcholine induced predominantly a vasodilator response, which was maximal during a 10(-5) M acetylcholine infusion. In contrast, in patients with coronary artery disease, acetylcholine caused dose-dependent vasoconstriction, which was observed even if the left anterior descending artery itself was smooth. Marked vasoconstriction was also induced in the patients with typical anginal pain and angiographically normal coronary arteries. In nine of these patients, this constrictor response was associated with anginal pain and electrocardiographic evidence of myocardial ischemia. Intracoronary administration of isosorbide dinitrate (1 mg) relieved the anginal pain and dilated all vessels. These data suggest that 1) patients with normal coronary arteriograms and angina pectoris manifest impairment of endothelium-dependent vasodilation similar to that observed in patients with overt coronary atherosclerosis; and 2) abnormal coronary vasoconstrictor responses resulting from this impairment may contribute to the pathogenesis of myocardial ischemia and angina in these patients.     

Role of purines in acetylcholine-induced coronary vasodilation

Acetylcholine, when infused directly into the coronary arteries, increases coronary flow and stimulation of the vagus causes parasympathetic coronary vasodilation. Recent evidence suggests that this acetylcholine-induced relaxation of coronary resistance vessels is not the result of a direct effect on vascular smooth muscle cells, but rather involves endothelial cell mediated release of some unidentified substance(s) [5]. Possible candidates which may participate in this coupling are adenine nucleotides and adenosine. These purine compounds which act on the surface of coronary myocytes via specific receptors are powerful dilators of coronary vessels [3, 8, 11]. We report here that stimulation of cardiac muscarinic receptors by acetylcholine causes a marked increase in the release of ATP, AMP, and adenosine into the coronary system of isolated guinea-pig hearts independent of myocardial oxygen consumption. The amounts of adenosine liberated appear quantitatively sufficient to be causally involved in the coronary dilatory action of acetylcholine.     

Vagal chemoreflex coronary vasodilation evoked by stimulating pulmonary C-fibers in dogs

We performed experiments on anesthetized, open-chest dogs to determine whether the pulmonary chemoreflex (bradycardia and systemic hypotension) evoked by stimulating pulmonary C-fibers also involves reflex changes in coronary vascular resistance. We perfused the circumflex coronary artery at constant pressure (usually 100 mm Hg) and recorded mean circumflex blood flow. Stimulation of pulmonary C-fibers by right atrial injection of capsaicin (10 micrograms/kg) decreased arterial blood pressure and heart rate and increased circumflex blood flow by 32-109% (P less than 0.001). Circumflex blood flow also increased, by 26-100% (P less than 0.001), when heart rate was kept constant by pacing. Coronary vasodilation was not secondary to the reflex decrease in arterial blood pressure. Injecting capsaicin (10 micrograms/kg) into the left atrium did not increase circumflex blood flow. Reflex coronary vasodilation could still be evoked when myelinated nerve fibers were blocked selectively by cooling the cervical vagus nerves to 7-8 degrees C but was abolished by cooling to 0 degrees C, by cutting the pulmonary vagal branches, or by giving atropine. Reducing coronary perfusion pressure shifted the stimulus (dose of capsaicin)-response (increase in coronary blood flow) curve to the right, but, even at low perfusion pressures, significant reflex vasodilation still occurred. Regional (transmural) distribution of myocardial blood flow was measured by the microsphere technique at various perfusion pressures. The endocardial:epicardial blood flow ratio decreased significantly as perfusion pressure was reduced, but was not altered by right atrial injection of capsaicin at any perfusion pressure. Our results indicate that stimulation of pulmonary C-fibers triggers reflex cholinergic vasodilation in all layers of the myocardium.     

Adrenergic blockade blunts adenosine concentration and coronary vasodilation during hypoxia.

Myocardial hypoxia is thought to be an important stimulus for increasing interstitial adenosine concentration. The adenosine hypothesis of coronary control was investigated during steady-state hypoxia by making measurements of coronary venous and epicardial well adenosine concentrations in adrenergically intact dogs and in animals with alpha- and beta-receptor blockade. In the adrenergically intact group, hypoxia sufficient to lower coronary venous oxygen tension to 8 mm Hg increased coronary blood flow 243% from normoxic values. Both coronary venous and epicardial well adenosine concentrations were increased throughout the hypoxic period. In the adrenergically blocked group, hypoxia to a similar level of coronary venous oxygen tension produced an increase in coronary blood flow of only 75%, which was significantly less than in the adrenergically intact group (p less than 0.01). Coronary venous adenosine was only transiently elevated, and epicardial well adenosine was unchanged from control levels. In a separate group of alpha- and beta-receptor-blocked animals that received an infusion of L-homocysteine thiolactone during hypoxia, there was no difference in tissue S-adenosylhomocysteine levels compared with those of normoxic controls. It is concluded that much of the coronary vasodilation associated with systemic hypoxia is dependent on adrenergic activation and that adenosine may only play a role in sustained hypoxic vasodilation when adrenergic receptors are intact.     

Epoxygenase metabolites contribute to nitric oxide-independent afferent arteriolar vasodilation in response to bradykinin

In the kidney, epoxyeicosatrienoic acids (EETs) have been suggested to be endothelium-derived hyperpolarizing factors (EDHFs). The aim of the present study was to determine the contribution of EETs to the preglomerular vasodilation elicited by bradykinin. Sprague-Dawley rats were studied utilizing an in vitro perfused juxtamedullary nephron preparation. The afferent arteriolar diameter was determined and the diameter averaged 19 +/- 1 microm (n = 26) at a renal perfusion pressure of 100 mm Hg. Addition of 1, 10 and 100 nM bradykinin to the perfusate dose-dependently increased afferent arteriolar diameter by 5 +/- 1, 12 +/- 2 and 17 +/- 2%, respectively. The nitric oxide inhibitor N(omega)-nitro-L-arginine reduced bradykinin-induced afferent arteriolar vasodilation by 50%, and the diameter increased by 9 +/- 2% in response to 100 nM bradykinin. Epoxygenase inhibitors N-methylsulphonyl-6-(2-propargyloxyphenyl)hexanamide or miconazole greatly attenuated the nitric oxide-independent component of the vasodilation elicited by bradykinin. Cyclooxygenase (COX) inhibition attenuated the nitric oxide-independent vasodilation elicited by 1 nM bradykinin but did not significantly affect the vascular response to 100 nM bradykinin. Combined inhibition of nitric oxide, COX and epoxygenase pathways completely abolished bradykinin-mediated afferent arteriolar vasodilation. In additional studies, renal microvessels were isolated and incubated with bradykinin and samples were analyzed by NICI/GC/MS. Under control conditions, renal microvascular EET levels averaged 49 +/- 9 pg/mg/20 min (n = 7). In the presence of bradykinin, EET levels were significantly higher and averaged 81 +/- 11 pg/mg/20 min (n = 7). These data support the concept that EETs are EDHFs and contribute to the nitric oxide-independent afferent arteriolar vasodilation elicited by bradykinin.     

Inhibition of bradykinin vasodilation and potentiation of norepinephrine and angiotensin vasoconstriction by inhibitors of prostaglandin synthesis in skeletal muscle of the rat.

Recent reports have indicated that vascular responsiveness can be altered by exogenously administered or endogenously released prostaglandins. Furthermore, in certain tissues inhibitors of prostaglandin synthesis have been shown to limit the increase in blood flow in response to bradykinin and to enhance the reduction in blood flow in response to angiotensin and norepinephrine. These findings suggest an important local circulatory role for prostaglandins. We attempted to implicate further prostaglandins in local blood flow regulation by examining the effects of indomethacin (IND) and 5,8,11,14-eicosatetraynoic acid (ETA), inhibitors of prostaglandin synthesis, on microvascular arteriolar responses to bradykinin, prostaglandin E1 (PGE1), prostaglandin E2 (PGE2), histamine, norepinephrine, and angiotensin. Male Wistar rats were anesthetized with sodium pentobarbital, and their cremaster muscle was exteriorized and prepared for in vivo microscopic observation of microvessels. Changes in arteriolar luminal diameters in response to topical administration of vasoactive agents were quantified with an image-shearing measuring eyepiece in conjunction with a television microscope and recorder. Local administration of IND or ETA significantly reduced the arteriolar dilation elicited by bradykinin, whereas the responses to PGE1 and PGE2 remained unaltered. Responses to histamine, although somewhat reduced, were not significantly different from control. Vasoconstrictor responses of arterioles elicited by norepinephrine and angiotensin were potentiated by IND or ETA administration. These results indicate that prostaglandins synthetized in skeletal muscle microcirculation in situ (1) mediate, in part, vasodilator responses to bradykinin and (2) modulate vasoconstrictor responses to angiotensin and norepinephrine. Thus, these findings support the hypothesis that prostaglandins are local regulators of microvascular responsiveness.     

Hydroxyl radical mediates the endothelium-dependent relaxation produced by bradykinin in mouse cerebral arterioles

Bradykinin relaxes arterioles on the brain's surface. This response is endothelium-dependent. The data presented here confirm the hypothesis that hydroxyl free radical mediates this response and may be the endothelium-dependent relaxing factor for bradykinin in this microvascular bed. The response to a locally applied bolus of bradykinin (80 micrograms/ml) was monitored by intravital TV microscopy. The response was significantly inhibited or totally blocked by the presence of superoxide dismutase 60 U/ml, catalase 46 U/ml, or deferoxamine 0.1 or 0.2 mM. The superoxide dismutase scavenges superoxide radical, which is known to enter the subarachnoid space as a consequence of cyclooxygenase activation. Cyclooxygenase is activated by bradykinin. The superoxide can form H2O2, scavenged by catalase, and the two together generate hydroxyl. The formation of hydroxyl radical is catalyzed by iron. Deferoxamine 0.1 mM scavenges the iron, blocking the generation of hydroxyl. Deferoxamine 0.2 mM also directly scavenges the hydroxyl. None of the pharmacologic probes had an effect on arteriolar diameter when locally applied without bradykinin. Since the dilation produced by bradykinin was inhibited or totally blocked by probes that prevented hydroxyl formation or directly scavenged hydroxyl radical, that radical is either an essential mediator of the arteriolar relaxation, or is the endothelium-dependent relaxing factor for bradykinin in pial arterioles.     

Role of adenosine in coronary vasodilation during exercise

This study examined the hypothesis that increases in myocardial blood flow during exercise are mediated by adenosine-induced coronary vasodilation. Active hyperemia associated with graded treadmill exercise and coronary reactive hyperemia were examined in chronically instrumented awake dogs during control conditions, after intracoronary infusion of adenosine deaminase (5 units/kg/min for 10 minutes), and after adenosine receptor blockade with 8-phenyltheophylline. Both adenosine deaminase and 8-phenyltheophylline caused a rightward shift of the dose-response curve to intracoronary adenosine; 8-phenyltheophylline was significantly more potent than adenosine deaminase. Adenosine deaminase caused a 33 +/- 7 to 39 +/- 3% decrease in reactive hyperemia blood flow following coronary occlusions of 5-20 seconds duration, respectively, while 8-phenyltheophylline produced a 40 +/- 6 to 62 +/- 8% decrease in reactive hyperemia. Increasing myocardial oxygen consumption during treadmill exercise was associated with progressive increase of coronary blood flow. Neither adenosine deaminase nor 8-phenyltheophylline attenuated the increase in coronary blood flow or the decrease of coronary vascular resistance during exercise. Neither agent altered the relation between myocardial oxygen consumption and coronary blood flow. Thus, although both adenosine deaminase and 8-phenyltheophylline antagonized coronary vasodilation in response to exogenous adenosine and blunted coronary reactive hyperemia, neither agent impaired coronary vasodilation associated with increased myocardial oxygen requirements produced by exercise. These findings fail to support a substantial role for adenosine in mediating coronary vasodilation during exercise.     

Angiographically documented coronary steal phenomenon evoked by the intracoronary infusion of bradykinin

While studying flow-dependent coronary dilation using a Doppler flow velocity guidewire, total occlusion of a stenosed segment of the left circumflex artery during the intracoronary infusion of bradykinin was angiographically documented. Total occlusion was not demonstrated during intracoronary infusion of bradykinin after angioplasty. This is angiographic confirmation of the coronary steal phenomenon that has been previously described in the field of stress scintigraphy.