Artikel
Endothelium-dependent vasodilation in forearm skin microcirculation is a surrogate for coronary vasomotion in CAD
Die Endothel-abhängige Vasodilatation in der Unterarm-Hautmikrozirkulation ist ein Surrogat für die koronare Vasomotion bei KHK-Patienten
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Autoren
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H. Bruck
- Universitätsklinikum Essen (Essen, D)
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C. Naber
- Universitätsklinikum Essen (Essen, D)
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D. Baumgart
- Universitätsklinikum Essen (Essen, D)
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R.F. Schäfers
- Universitätsklinikum Essen (Essen, D)
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R. Erbel
- Universitätsklinikum Essen (Essen, D)
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T. Philipp
- Universitätsklinikum Essen (Essen, D)
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R.R. Wenzel
- Universitätsklinikum Essen (Essen, D)
| Veröffentlicht: | 11. November 2004 |
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Gliederung
Text
Objectives
In coronary artery disease (CAD) endothelial function may be disturbed in an early phase of the disease; endothelial dysfunction can be quantified by assessing coronary dilatation to acetylcholine (Ach).
The study aimed to investigate whether in patients with CAD endothelium-dependent vasomotion measured invasively by quantitative coronary angiography is related to vasomotion in skin microcirculation.
Methods
7 patients (2 female, 5 male, mean age 54±4 years, BMI 26±2 kg/m2) with CAD underwent invasive coronary angiography and were intracoronary infused with Ach (10-6 to 10-8 mol). Ach-effects were measured by quantitative coronary angiography (in APV) and were correlated with changes in blood flow assessed with double-injection-technique and laser-Doppler flowmetry in the forearm skin microcirculation (in arbitrary perfusion units, PU) after intradermal injection of Ach (10-6 to 10-8 mol) [Fig. 1].
Results
In 6 patients Ach induced a dose-dependent vasodilatation of the coronary artery (delta APV for Ach 10-6: 7,5±2,3; Ach10-7: 0,83±0,8 and Ach10-8: -0,98±1,9) and in skin microcirculation (delta PU: Ach 10-6: 1396±331; Ach10-7: 1232±515 and Ach10-8: 582±358); in 1 patient Ach induced paradox vasoconstriction of the coronary artery and in skin microcirculation. Ach-induced changes in coronary artery perfusion significantly correlated with changes in skin microcirculation perfusion (p=0.04, r2=0,2, see figure). Furthermore, there was a positive correlation between serum LDL-levels with Ach-induced changes (p=0,02; r2=0,68 for the coronary artery and p=0,01; r2=0,76 for skin microcirculation).
Conclusion
In patients with CAD assessment of endothelium-dependent vasodilatation in the forearm skin microcirculation by double-injection technique and laser-Doppler-flowmetry is a minimal invasive test that predicts coronary endothelial function and correlates with serum LDL-cholesterol.
