Abstract
This study investigated arterial and coronary venous catecholamine concentrations in patients undergoing either elective coronary angioplasty (PTCA) or direct PTCA for acute myocardial infarction. We included 17 patients with stenoses of the left anterior descending coronary artery (LAD) and 10 patients with acute anterior myocardial infarction (AMI) undergoing PTCA. During the initial balloon dilatation arterial and coronary venous plasma concentrations of norepinephrine and epinephrine were determined. In elective PTCA, coronary occlusion (2 min) resulted in a transient increase of arterial concentrations of norepinephrine (2.04±0.30 vs. 1.26±0.13 nmol/L before dilatation) and epinephrine (0.52±0.08 vs. 0.34±0.04 nmol/L) in the first minute of reperfusion, whereas coronary venous concentrations of catecholamines were not changed after dilation. Among the 10 patients with AMI, immediate reperfusion of the LAD (TIMI grade 3) was achieved in 6 patients. In these patients, baseline arterial concentrations for norepinephrine (3.91±1.16 nmol/L) and epinephrine (4.68±2.07 nmol/L) were elevated and no transcardiac gradient for catecholamines was found. In the first minute after successful reopening of the LAD we detected a distinct rise of the transcardiac norepinephrine gradient from −0.10±0.53 to 85.02±24.64 nmol/L, which declined in the fifth minute of reperfusion to 4.36±2.30 nmol/L. Conversely, venous epinephrine and arterial concentrations for both catecholamines remained unchanged within the observation period. In the four patients with incomplete (TIMI 0–2) reopening of the LAD, we found no cardiac washout of norepine phrine. In summary, a transient rise of systemic catecholamines, but no cardiac release of norepinephrine was observed in patients after brief coronary occlusion. Conversely, a massive washout of norepinephrine from the infarcted myocardium occurred during AMI.
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References
Emanuelsson H, Mannheimer C, Waagstein F (1991) Changes in arterial levels and myocardial metabolism of catecholamines during pacing-induced angina pectoris. Clin Cardiol 14: 567–72
Schwartz L, Sole MJ, Vaughan-Neil EF, Hussain NM (1979) Catecholamines in coronary sinus and peripheral plasma during pacing-induced angina in man. Circulation 59: 37–43
McCance AJ, Forfar JC (1991) Coronary venous noradrenaline during coronary angioplasty. Int J Cardiol 33: 89–98
Remme WJ, Kruyssen DACM, Look MP, Bootsma M, deLeeuw PW (1994) Systemic and cardiac neuroendocrine activation and severity of myocardial ischemia in humans. J Am Coll Cardiol 23: 82–91
Schömig A, Richardt G (1990) Cardiac sympathetic activity in myocardial ischemia: release and effects of noradrenaline. Bas Res Cardiol 85 (suppl 1): 9–30
Schömig A, Dart AM, Dietz R, Mayer E, Kübler W (1984) Release of endogenous catecholamines in the ischemic myocardium of the rat. Part B: Locally mediated release. Circ Res 55: 689–701
Serruys PW, Wijns W, van den Brand M, Meij S, Slager C, Schuuerbiers JCH, Hugenholtz PG, Brower RW (1984) Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty. Circulation 70: 25–36
Feldman RA, MacDonald RG, Hill JA, Limacher MC, Conti R, Pepine CJ (1986) Effect of propranolol on myocardial ischemia occurring during acute coronary occlusion. Circulation 73: 727–33
Peuhkurinen K, Ikäheimo M, Airaksinen J, Huikuri H, Linnualuoto M, Takkunen J (1991) Changes in myocardial energy metabolism in elective coronary angioplasty. Cardiovasc Res 25: 158–63
Grines CL and the primary angioplasty in myocardial infarction group (1993) A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. New Engl J Med 328: 673–79
Hillis LD, Foreman S, Braunwald E (1990) Risk stratification before thrombolytic therapy in patients with acute myocardial infarction. J Am Coll Cardiol 16: 313–21
Smedes F, Kraak JC, Poppe H (1982) Simple and fast solvent extraction system for selective and quantitative isolation of adrenaline, noradrenaline and dopamine from plasma and urine. J Chromatogr 231: 25–39
Goldstein DS (1981) Plasma norepinephrine as an indicator of sympathetic neural activity in clinical cardiology. Am J Cardiol 48: 1147–54
Malliani A, Schwartz PJ, Zanchetti A (1969) A sympathetic reflex elicited by experimental coronary occlusion. Am J Physiol 217: 703–09
Felder RB, Thames MD (1981) The cardiocardiac sympathetic reflex during coronary occlusion in anesthetized dogs. Circ Res 48: 685–92
Karlsberg RP, Penoske PA, Cryer PE, Corr PB, Roberts R (1979) Rapid activation of the sympathetic nervous system following coronary occlusion: relationship to infarct size, site, and hemodynamic impact. Cardiovasc Res 13: 523–31
Emanuelsson H, Mannheimer C, Waagstein F, Wilhelmsson C (1987) Catecholamine metabolism during pacing-induced angina pectoris and the effect of transcutaneous electrical nerve stimulation. Am Heart J 114: 1360–66
McCance AJ, Forfar JC (1989) Cardiac and whole body [3H] noradrenaline kinetics in ischaemic heart disease: contrast between unstable syndromes and pacing induced ischaemia. Br Heart J 61: 238–47
Langer SZ (1981) Presynaptic regulation of the release of catecholamine. Pharmacol Rev 32: 337–362
Siegel JH, Gimore JP, Sarnoo SJ (1961) Myocardial extraction and production of catecholamines. Circ Res 9: 1336–50
Müller HS, Rao PS, Rao PB, Gory DJ, Mudd JG, Ayres SM (1982) Enhanced transcardiac I-norepinephrine response during cold pressor test in obstructive coronary artery disease. Am J Cardiol 50: 1223–28
Neri-Serneri GG, Boddi M, Arata L, Rostagno C, Dabizzi P, Coppo M, Bini M, Lazzerini S, Dagianti A, Gensini GF (1993) Silent ischemia in unstable angina is related to an altered norepinephrine handling. Circulation 87: 1928–37
Yamaguchi N, deChamplain J, Nadeau RA (1975) Regulation of norepinephrine release from cardiac sympathetic fibers in the dog by presynaptic α- and β-receptors. Circ Res 41: 108–17
Cousineau D, Ferguson RJ, De Champlain J, Gauthier P, Cote P, Bourassa M (1977) Catecholamines in coronary sinus during exercise in man before and after training. J Appl Physiol 43: 801–06
Dart AM, Schömig A, Dietz R, Mayer E, Kübler W (1984) Release of endogenous catecholamines in the ischemic myocardium of the rat. Part A: Effect of sympathetic nerve stimulation. Circ Res 55: 702–706
Esler M, Jennings G, Lambert G, Meredith I, Horne M, Eisenhofer G (1990) Overflow of catecholamine neurotransmitters to the circulation: source, fate, and function. Physiol Rev 70: 963–985
Seyfarth M, Feng Y, Hagl S, Sebening F, Richardt G, Schömig A (1993) Effect of myocardial ischemia on stimulation-evoked nordadrenaline release: modulated neurotransmission in rat, guinea pig and human atrial tissue. Circ Res 73: 496–502
Richardt G, Waas W, Kranzhöfer R, Mayer E, Schömig A (1987) Adenosine inhibits exocytotic release of endogen ous noradrenaline in the rat heart: A protective mechanism in early myocardial ischemia. Circ Res 61: 117–23
Miyazaki T, Zipes DP (1990) Tresynaptic modulation of efferent sympathetic neurotransmission in the canine heart by hypoxia, high K+, low pH and adenosine. Possible relevance in ischemia induced denervation. Circ Res 66: 289–301
Schömig A (1989) Increase of cardiac and systemic catecholamines in myocardial ischemia. In: Brachmann J, Schömig A (Eds) Adrenergic System and Ventricular Arrhythmias in Mecurdial Infarction. Springer Verlag, New York Berlin Heidelberg, pp 61–67
Kurz T, Richardt G, Hagl S, Seyfarth M, Schömig A (1995) Two different mechanisms of noradrenaline release during normoxia and simulated ischemia in human cardiac tissue. J Mol Cell Cardiol 27: 1161–1172
Dart AM, Riemersma RA (1988) Origins of endogenous noradrenaline verflow during reperfusion of the ischemic rat heart. Clinical Sci 74: 269–74
Rothman MT, Baim DS, Simpson JB, Harrison DC (1982) Coronary hemodynamics during percutaneous transluminal angioplasty. Am J Cardiol 49: 1615–22
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Richardt, G., Munch, G., Neumann, F.J. et al. Systemic and cardiac catecholamines during elective PTCA and during immediate PTCA for acute myocardial infarction. Basic Res Cardiol 92, 52–60 (1997). https://doi.org/10.1007/BF00803757
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DOI: https://doi.org/10.1007/BF00803757