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January 1, 1988Journal of Clinical InvestigationOpen Access

Responses of coronary arteries of cardiac transplant patients to acetylcholine.

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Why the study?

Does intracoronary acetylcholine induce paradoxical vasoconstriction in the coronary arteries of cardiac transplant patients?

Population

13 consecutive patients who had undergone cardiac transplantation 1 year or 2 years previously, undergoing…

Comparison

Intracoronary infusion of acetylcholine into the… vs Control infusions and intra-patient comparison…

Design

Cohort, Blinded outcome assessment.

Authors

RFR. David FishUniversity Hospitals of North Midlands NHS TrustENE G NabelBrigham and Women's HospitalASAndrew P. SelwynCardiac Imaging

Discussion

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Implication

Endothelial dysfunction may precede visible graft atherosclerosis in transplants; leaves open acetylcholine testing for routine surveillance.

Key Points

  • To determine whether coronary arteries of cardiac transplant recipients display endothelial dysfunction prior to or during the early stages of angiographically detectable graft atherosclerosis.
  • Assessed 13 heart transplant patients at 12 months (n = 9) or 24 months (n = 4) post-transplantation.
  • Infused acetylcholine into the left anterior descending coronary artery and measured segment diameter changes using quantitative coronary angiography, followed by nitroglycerin infusion.
  • Among angiographically smooth segments, only 6 of 25 showed normal vasodilation, 10 of 25 failed to dilate, and 9 of 25 paradoxically constricted.
  • In three patients with angiographically irregular vessels, 8 of 10 segments exhibited marked paradoxical constriction and 2 of 10 failed to dilate.
  • Only 1 of 13 patients maintained normal dilation across all segments in response to acetylcholine, whereas nitroglycerin successfully dilated nearly all segments regardless of rejection status.

Structured PICO

Does intracoronary acetylcholine induce paradoxical vasoconstriction in the coronary arteries of cardiac transplant patients?

P
Population
13 consecutive patients who had undergone cardiac transplantation 1 year (n=9) or 2 years (n=4) previously, undergoing routine annual catheterization.
I
Intervention
Intracoronary infusion of acetylcholine (graded concentrations 10^-9 to 10^-6 M) into the left anterior descending coronary artery.
C
Comparator
Control infusions (5% dextrose in water) and intra-patient comparison with direct smooth muscle dilator nitroglycerin (40 μg).
O
Outcome
Vascular response (change in luminal diameter) evaluated by quantitative coronary angiography.surrogate

Impaired endothelium-mediated coronary vasodilation (paradoxical constriction to acetylcholine) is a common early finding in cardiac transplant patients, suggesting endothelial dysfunction precedes angiographically evident graft atherosclerosis.

Limitations

  • Small sample size (larger numbers of patients may be required to reach definitive conclusions)

Cite This Study

Fish et al. (1988) studied this question.

synapsesocial.com/papers/6a1571ea3e2c796fc9820315https://doi.org/10.1172/jci113297

Topics

Coronary artery diseaseHeart transplantationCoronary CT angiography
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Selective coronary angiography using a power injector1986 · 30 citations
  2. 2Paradoxical Vasoconstriction Induced by Acetylcholine in Atherosclerotic Coronary Arteries1986 · 2,429 citations
  3. 3Short- and long-term interactions of endothelium and vascular smooth muscle in coculture: effects on cyclic GMP production.1986 · 56 citations
  4. 4Computerized image analysis for quantitative measurement of vessel diameter from cineangiograms.1983 · 198 citations