PMID- 9649924
OWN - NLM
STAT- MEDLINE
DCOM- 19980917
LR  - 20191024
IS  - 0954-6928 (Print)
IS  - 0954-6928 (Linking)
VI  - 9
IP  - 4
DP  - 1998
TI  - Influence of the culprit lesion on clinical symptoms of coronary artery disease, 
      with special emphasis on exercise data.
PG  - 185-90
AB  - BACKGROUND: Clinical symptoms have been found to correlate only poorly with the 
      severity of the culprit lesion in coronary artery disease. The purpose of the 
      present study was to evaluate the influence of the culprit lesion and its change 
      during exercise on clinical symptoms in patients with this condition. METHODS: 
      Minimal luminal area was determined using biplane quantitative coronary 
      angiography in 42 patients (aged 53 +/- 8 years) with coronary artery disease. 
      Percent diameter stenosis and minimal luminal area and its change during exercise 
      were assessed in all patients and compared with clinical symptoms judged 
      according to the functional classification of the New York Heart Association 
      (NYHA). Coronary dimensions were determined with the patient at rest, during 
      supine bicycle exercise and after sublingual administration of 1.6 mg glyceryl 
      trinitrate. RESULTS: Exercise-induced vasoconstriction of the culprit lesion was 
      found in all patients (-14.0% at 102 W), but there was exercise-induced 
      vasodilatation in the normal vessel segments (+13.0%). However, only minimal 
      vasoconstriction was found in groups 1 (NYHA I: -0.5%, NS) and 2 (NYHA II: -4.7%, 
      NS), but significant constriction in groups 3 (NYHA II-III: -18.0%, P < 0.01) and 
      4 (NYHA III: -31.4, P < 0.01). Vasodilatation of the normal vessel segments was 
      similar in the four groups. The observed inverse relationship between 
      exercise-induced changes in minimal luminal area and NYHA classification was 
      stronger than the relationship between NYHA and minimal luminal area when the 
      patient was at rest. There was no correlation between glyceryl trinitrate-induced 
      vasodilatation and NYHA classification. CONCLUSIONS: The more severe the culprit 
      lesion, the more pronounced the exercise-induced vasoconstriction. This effect of 
      the culprit lesion was reflected by the clinical symptoms: the greater the 
      exercise-induced vasoconstriction, the higher the NYHA classification. Thus the 
      anatomy of the lesion (= severity) and the functional integrity of the 
      endothelium (= exercise-induced vasomotion) are two major determinants of 
      clinical symptoms.
FAU - Kaufmann, P
AU  - Kaufmann P
AD  - Department of Cardiology, University Hospital, Zurich, Switzerland.
FAU - Mandinov, L
AU  - Mandinov L
FAU - Frielingsdorf, J
AU  - Frielingsdorf J
FAU - Hess, O M
AU  - Hess OM
LA  - eng
PT  - Journal Article
PL  - England
TA  - Coron Artery Dis
JT  - Coronary artery disease
JID - 9011445
RN  - G59M7S0WS3 (Nitroglycerin)
SB  - IM
MH  - Cardiac Catheterization
MH  - Coronary Angiography
MH  - Coronary Disease/diagnostic imaging/pathology/*physiopathology
MH  - Coronary Vessels/*pathology/physiopathology
MH  - *Exercise Test
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nitroglycerin/pharmacology
MH  - Vasoconstriction
MH  - Vasodilation
EDAT- 1998/07/03 00:00
MHDA- 1998/07/03 00:01
CRDT- 1998/07/03 00:00
PHST- 1998/07/03 00:00 [pubmed]
PHST- 1998/07/03 00:01 [medline]
PHST- 1998/07/03 00:00 [entrez]
AID - 10.1097/00019501-199809040-00003 [doi]
PST - ppublish
SO  - Coron Artery Dis. 1998;9(4):185-90. doi: 10.1097/00019501-199809040-00003.