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. 2000 Nov;84(5):529–534. doi: 10.1136/heart.84.5.529

Complex stenosis morphology and vasomotor responses to inhibition of nitric oxide synthesis

D Tousoulis 1, C Tentolouris 1, T Crake 1, G Goumas 1, C Stefanadis 1, P Toutouzas 1, G Davies 1
PMCID: PMC1729469  PMID: 11040015

Abstract

OBJECTIVE—To assess the relation between coronary vasomotor effects of NG-monomethyl-L-arginine (LNMMA) administration and coronary stenosis morphology, length, and severity in patients with stable angina.
DESIGN—In 28 patients (24 male, four female) with coronary artery disease and chronic stable angina, intracoronary normal saline and 4 µmol/min LNMMA were infused for four minutes each, followed by an intracoronary bolus of 250 µg glyceryl trinitrate. Coronary stenoses were classified as concentric (smooth), eccentric (smooth), or complicated (irregular). The diameters of these stenoses and their adjacent reference proximal segments were measured by quantitative angiography.
RESULTS—During LNMMA infusion a significantly larger proportion of complicated stenoses than concentric and eccentric stenoses constricted by ⩾ 5% (p < 0.01) and the magnitude of vasoconstriction was greater in complicated than in concentric and eccentric stenoses (p < 0.05). For complicated stenoses the magnitude of constriction (in mm) with reference to normal saline was greater than that of the concentric and eccentric stenoses (p < 0.05), whereas concentric and eccentric stenoses constricted similarly. Irrespective of the type of morphology, there was a correlation (p < 0.05) between both the severity and the length of stenoses and the magnitude of vasoconstriction to LNMMA. A similar proportion of concentric, eccentric, and complicated stenoses showed ⩾ 5% increase in diameter with glyceryl trinitrate, and the magnitude of the response was similar in the three groups.
CONCLUSIONS—In patients with coronary artery disease, the response to LNMMA is greater when stenosis morphology is complex, indicating greater nitric oxide activity. This provides further evidence that plaques with complex morphology are in an active state.


Keywords: endothelium; nitric oxide; coronary artery disease; stenosis morphology

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Figure 1  .

Figure 1  

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Mean coronary stenosis response (per cent change from baseline) to NG-monomethyl-L-arginine (LNMMA) and glyceryl trinitrate (nitrates) for concentric, eccentric, and complicated stenoses. In response to LNMMA, complicated stenoses showed significantly greater constriction (p < 0.05) than concentric or eccentric stenoses. No differences were found in response to nitrates in these three morphologies.

Figure 2  .

Figure 2  

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Individual lumen diameter per cent change from baseline in concentric, eccentric, and complicated stenoses after LNMMA infusion. Horizontal bars indicate the mean values.

Figure 3  .

Figure 3  

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The magnitude of stenosis and of reference (ref) segment constriction are expressed as diameter after saline minus diameter after LNMMA (mm) for concentric, eccentric, and complicated stenoses. Complicated stenoses showed significantly greater constriction (p < 0.05) than concentric or eccentric stenoses.

Figure 4  .

Figure 4  

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Correlations between stenosis length (right panel), stenosis severity (middle panel), stenosis eccentricity ratio (left panel), and the magnitude of LNMMA response, expressed as per cent change in coronary artery diameter from baseline. Linear regression analysis showed a significant correlation between stenosis severity and LNMMA response, and between stenosis length and LNMMA response.

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