Original Article

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 32, Issue 12, pp 1371-1377

First online:

Beneficial effects of atorvastatin on myocardial regions with initially low vasodilatory capacity at various stages of coronary artery disease

  • Peter WieleppAffiliated withInstitute of Molecular Biophysics, Radiopharmacy and Nuclear Medicinea, Ruhr-University BochumHeart and Diabetes Center North Rhine-Westphalia Email author 
  • , Detlev BallerAffiliated withDepartment of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University BochumHeart and Diabetes Center North Rhine-Westphalia
  • , Ulrich GleichmannAffiliated withDepartment of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum
  • , Ewa PulawskiAffiliated withDepartment of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum
  • , Dieter HorstkotteAffiliated withDepartment of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum
  • , Wolfgang BurchertAffiliated withInstitute of Molecular Biophysics, Radiopharmacy and Nuclear Medicinea, Ruhr-University Bochum

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Abstract

Purpose

The aim of this study was to analyse non-invasively the regional effect of therapy with an HMG-CoA reductase inhibitor on myocardial blood flow in patients with coronary artery disease (CAD) with special reference to segments with initially substantially impaired vasodilation.

Methods

The study included 26 patients with untreated hypercholesterolaemia. Coronary angiography revealed CAD in nine patients with stenosis >50% and wall irregularities or minimal stenosis <30% in 17 patients. Before and 4.6±1.8 months after atorvastatin therapy, 13N-ammonia positron emission tomography (PET) studies were performed at rest and under pharmacological stress. Minimum coronary vascular resistance (MCR) and coronary flow reserve (CFR) were determined. Segments were divided into those with normal or near-normal (MBF during adenosine ≥2.0 ml/min/g) and those with abnormal (MBF<2.0 ml/min/g) vasodilator flow response. In CAD patients, 156 segments were analysed, 85 of which had abnormal MBF; in the non-obstructive group, 59 of 297 segments had abnormal MBF.

Results

LDL cholesterol decreased after atorvastatin therapy from 186±43 mg/dl to 101±26 mg/dl (p<0.001). In normal segments no significant changes in MBF, CFR and MCR were found. However, initially abnormal segments showed significant improvements in MCR (15%, p<0.0001) and MBF during adenosine (30%, p<0.0001) after therapy.

Conclusion

The improvement in regional coronary vasodilator function after atorvastatin in patients with coronary atherosclerosis may be caused, at least in part, by increased flow-mediated (endothelium-dependent) dilation of the total arteriolar and arterial vascular system. These data further support the concept of non-invasive management of stable CAD by statin therapy and life-style modification guided by PET.

Keywords

Coronary artery disease Hypercholesterolaemia Atherosclerosis Lipid-lowering drugs Positron emission tomography