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Variable Response of Conductance and Resistance Coronary Arteries to Endothelial Stimulation in Patients With Heart Failure Due to Nonischemic Dilated Cardiomyopathy

Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California

Amir Lerman, MD

The Center of Coronary Physiology and Imaging, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester Minnesota

Mohammed W. Akhter, MD

Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California

Parta Hatamizadeh, MD

Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California

Munir Janmohamed, MD

Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California

Salman Khan, MD

Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California

Uri Elkayam, MD

Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, elkayam{at}usc.edu

Attenuation of endothelial-dependent coronary vasodilation has been reported in idiopathic dilated cardiomyopathy and anatomically normal coronaries; however, data are insufficient for understanding the incidence and extent of this finding. The response of conductance and resistance coronary arteries to endothelial stimulation with acetylcholine was examined in 25 patients. Coronary blood flow had a variable response to acetylcholine and suggested coronary endothelial dysfunction in approximately half of the patients. Abnormal endothelial dysfunction involved the large conductance epicardial coronary arteries and the small resistance vessels. Abnormal endothelial response of coronary blood flow to acetylcholine could not be predicted by demographic and hemodynamic data. Conclusions: Coronary artery endothelial function is heterogeneous in patients with idiopathic dilated cardiomyopathy. Endothelial dysfunction is present in approximately half of the cases and involves both resistance as well as conductance coronary blood vessels. Furthermore, coronary endothelial function cannot be predicted by demographic and hemo-dynamic parameters or left ventricular ejection fraction.

Key Words: endothelium • regional blood flow • heart failure

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 11, No. 3, 197-202 (2006)
DOI: 10.1177/1074248406292574


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