Key result
Intracoronary salbutamol provocation revealed significant endothelium-dependent vasodilatation in mid and distal segments, but not in the left main (P=0.16) or proximal epicardial segments (P=0.45).
Why the study?
Does intracoronary salbutamol provocation reveal heterogenous endothelium-dependent vasomotor reactivity across different coronary segments in patients undergoing coronary angiography?
Observational (n=30)
Does intracoronary salbutamol provocation reveal heterogenous endothelium-dependent vasomotor reactivity across different coronary segments in patients undergoing coronary angiography?
Endothelium-dependent vasomotor reactivity is heterogenous within the coronary system, with less prominent dynamic responses in the larger calibre LMCA and proximal epicardial segments.
Answers are grounded in this paper and cite their sources.
Supports heterogeneous coronary endothelial reactivity; hypothesis-generating for segment-specific vasomotor assessment.
AIMS: While the relationship between epicardial coronary vasomotor reactivity and cardiovascular events is well established, this observation has yet to be evaluated within the left main coronary artery (LMCA) in humans in vivo. Our aims were to test the endothelium-dependent vasomotor properties of the LMCA, and to compare these responses to downstream epicardial segments. METHODS AND RESULTS: Thirty patients referred for coronary angiography underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound imaging within a non-critically diseased, left-sided conduit vessel. Macrovascular vasomotor response [change in average lumen area (LA) at baseline and following 5 min of 0.30 µg/min IC salbutamol] and percent atheroma volume (PAV) were evaluated in 30 LMCA, 42 proximal, 109 mid, and 132 distal epicardial coronary segments. In comparison with all other segments, the LMCA had the greatest lumen and vessel areas (P < 0.001), yet the proximal epicardial segments contained the greatest PAV (P < 0.02). The mid and distal epicardial segments displayed significant endothelium-dependent vasodilatation from baseline (P = 0.017 and <0.001, respectively); however, the proximal epicardial and LMCA segments did not (P = 0.45 and 0.16, respectively). Significant segmental vasomotor heterogeneity was noted in all 30 patients, with opposing vasomotor responses between adjacent LMCA and epicardial segments. Across all segments, baseline LA inversely correlated with the % change in LA (r = -0.16, P = 0.0005). CONCLUSION: Endothelium-dependent vasomotor reactivity is heterogenous within the conduit coronary system. Vascular dynamic responses were less prominent in the larger calibre LMCA and proximal epicardial segments. This may, in part, relate to higher shear stress in smaller, distal segments and yet also may explain the propensity for culprit plaques to cluster proximally.
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Puri et al. (2014) conducted an observational in Coronary artery disease (n=30). Intracoronary salbutamol vs. Baseline was evaluated on Change in average lumen area. Intracoronary salbutamol provocation revealed significant endothelium-dependent vasodilatation in mid and distal segments, but not in the left main (P=0.16) or proximal epicardial segments (P=0.45).
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