Influence of differential vascular remodeling on the coronary vasomotor response

doi:10.1016/S0008-6363(03)00396-1

Cardiovascular Research 2003 59(2):520-526; doi:10.1016/S0008-6363(03)00396-1
© 2003 by European Society of Cardiology

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Influence of differential vascular remodeling on the coronary vasomotor response

Andrew L. McLeod^a^,b, David E. Newby^a^,*, David B. Northridge^b, Keith A.A. Fox^a and Neal G. Uren^a

^aDepartment of Cardiology, Royal infirmary, 51 Little France Crescent, Little France, Edinburgh EH16 4SA, UK
^bDepartment of Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK

^* Corresponding author. Tel.: +44-131-242-6422; fax: +44-131-242-6422. d.e.newby{at}ed.ac.uk

Objectives: Arterial remodeling may increase or decrease theluminal encroachment of atherosclerotic plaques in the coronarycirculation. However, the factors determining the nature andconsequences of the remodeling process remain poorly characterized.The study aims were to assess whether the pattern of vascularremodeling influences the physical and vasomotor responses ofthe coronary arteries in vivo in man. Methods: Coronary vesselarea, distensibility and stiffness were determined in positively,negatively and non-remodeled arterial segments using intravascularultrasound and Doppler flow measurement. Epicardial vasomotorresponses were determined following intracoronary boluses ofacetylcholine (10^–6 and 10^–4 M), adenosine (24–30µg) and nitroglycerin (200 µg). Results: Fifty-sixcoronary arterial segments were studied in 25 patients. In comparisonto non- and positively remodeled segments, negatively remodeledsegments had a higher stiffness index (67±16 vs. 33±5and 38±8, respectively; P<0.02) and appeared to havelower compliance and distensibility (0.66±0.17 vs. 1.65±0.54and 0.94±0.18/mmHg; P = NS). Non-remodeled segments hada greater change in vessel area with 10^–6 M acetylcholine(4.9±0.8%), compared to positively and negatively remodeledsegments (0.6±1.8% and –4.9±1.8%, respectively,P<0.05). A significant degree of preservation of vasodilatationto 10^–6 M acetylcholine was evident in positively remodeledcompared with negatively remodeled segments (P<0.05). Nitroglycerincaused greater vasodilatation in non-remodeled segments (7.2±3.8%)than either positively or negatively remodeled segments (4.7±0.9and 3.7±0.6%, respectively, P<0.05). Conclusions:Vascular remodeling is an important and major determinant oflocal epicardial vasomotor responses. Both structural and functionalabnormalities are associated with negative remodeling that maycontribute to the adverse effects of such lesions.

KEYWORDS Coronary circulation; Endothelial function; Blood flow; Remodeling; Acetylcholine

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