Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;22(11):699–703. doi: 10.1002/clc.4960221104

Impaired endothelial function in patients with rapidly stabilized unstable angina: Assessment by noninvasive brachial artery ultrasonography

Eulalio Bereziuk 1, Alberto L Bolaño 1, Daniel H Suarez 1, Marta Kura 1, Ricardo J Esper 1,✉, Jorge Vilariño 2, José L Cacharrón 3, Rogelio Machado 3, Carlos A Ingino 3, Carlos A GarcGuiñaz 3
PMCID: PMC6655518  PMID: 10554683

Abstract

Background:Endothelial dysfunction may contribute to symptoms of instability in patients with acute coronary syndromes. High‐resolution external ultrasound assessment of the brachial artery responses allows noninvasive determination of endothelial function.

Hypothesis:This study was conducted to assess endothelial function in patients with unstable angina using a noninvasive technique.

Methods:We studied 189 patients who were subdivided into three groups. Group 1:60 apparently healthy subjects with no cardiovascular risk factors or symptoms of coronary artery disease; Group 2: 105 subjects with cardiovascular risk factors—arterial hypertension, hypercholesterolemia, cigarette smoking, diabetes, and obesity, but no evidence of coronary artery disease; and Group 3: 24 patients with unstable angina (chest pain at rest within the 24 h preceding study entry). All patients underwent pre‐ and postischemic brachial artery test evaluation with measurements of internal arterial diameters and blood flow.

Results:Results are expressed as percentage change from basal values. Subjects in Groups 1 and 2 showed a diameter increase of 19.1 and 11.9%, respectively, whereas patients in Group 3 showed a diameter change of 1.2% (p < 0.002 and < 0.0001, respectively). Calculated blood flow did not differ significantly in Groups 1 or 2 (74.4 and 56.4%), but was notably lower in Group 3 (18.4%, p<0.005 vs. Groups 1 and 2). In nine patients of Group 3, the brachial studies were repeated 4 weeks after symptom stabilization and showed values comparable with those in Group 2.

Conclusions:Patients with unstable angina showed endothelial dysfunction compared with control individuals. It is of interest that in patients whose symptoms were stabilized by medical therapy, endothelial function was restored 4 weeks after hospital discharge.

Keywords: atherosclerosis, endothelial dysfunction, coronary disease, unstable angina

Full Text

The Full Text of this article is available as a PDF (551.3 KB).

References

  • 1. Berliner JA, Navab M, Fogelman AM, Frank JS, Demer L, Edwards PA, Watson AD, Lusis AJ: Atherosclerosis: Basic mechanisms oxidation, inflammation, and genetics. Circulation 1995; 91: 2488–2496 [DOI] [PubMed] [Google Scholar]
  • 2. Jones CJH, Kuo L, Davis MJ, DeFily DV, Chilian WM: Role of nitric oxide in coronary microvascular responses to adenosine and increased metabolic demand. Circulation 1996; 91: 1807–1813 [DOI] [PubMed] [Google Scholar]
  • 3. Cooke JP, Tsao PS: Is NO an endogenous antiatherogenic molecule? Arterioscler Thromb 1994; 14: 753–759 [DOI] [PubMed] [Google Scholar]
  • 4. Loscalzo J, Welch G: Nitric oxide and its role in the cardiovascular system. Prog Cardiovasc Dis 1995; 38: 87–104 [DOI] [PubMed] [Google Scholar]
  • 5. Ludmer PL, Selwyn AP, Shook TL, Wayne RR, Mudge GH, Alexander RW, Ganz P: Paradoxical vasoconstriction induced by acetylcholine in atherosclerosis coronary arteries. N Engl J Med 1986; 315: 1046–1051 [DOI] [PubMed] [Google Scholar]
  • 6. Celermajer DS, Sorensen KE, Bull C, Robinson J, Deanfield JE: Endothelium‐dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol 1994; 24: 1468–1474 [DOI] [PubMed] [Google Scholar]
  • 7. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, Lloyd JK, Deanfield JE: Non‐invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340: 1111–1115 [DOI] [PubMed] [Google Scholar]
  • 8. Anderson TJ, Uehata A, Gerard MD, Meredith IT, Knab S, Delagrande D, Lieberman EH, Ganz P, Creager MA, Yeung AG, Selwyn AP: Close relation of endothelial function in the human coronary and peripheral circulation. J Am Coll Cardiol 1995; 26: 1235–1241 [DOI] [PubMed] [Google Scholar]
  • 9. Sorensen KE, Kristensen IB, Celermajer DS: Atherosclerosis in the human brachial artery. J Am Coll Cardiol 1997; 29: 318–322 [DOI] [PubMed] [Google Scholar]
  • 10. Vilariñio JO, Cacharrón JL, Suarez DH, Kura M, Machado R, Bolaño A, Esper RJ: Evaluación de la función endotelial por eco‐Doppler. Influencia de la edad, sexo y factores de riesgo. Rev Argent Cardiol 1998; 66: 523–532 [Google Scholar]
  • 11. Creager MA, Cooke JP, Mendelsohn ME, Gallagher SJ, Coleman SM, Loscalzo J, Dzau VJ: Impaired vasodilatation of forearm resistance vessels in hypercholesterolemic humans. J Clin Invest 1990; 86: 228–234 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Celermajer DS, Sorensen KE, Georgakopuolos D, Bull C, Thomas O, Robinson J, Deanfield JE: Cigarette smoking is associated with dose‐related and potentially reversible impairment of endothelium‐dependent dilation healthy young adults, Circulation 1993; 88 (part 1): 2149–2155 [DOI] [PubMed] [Google Scholar]
  • 13. Zeiher A, Schächinger V, Minners J: Long‐term cigarette smoking impairs endothelium‐dependent coronary vasodilator function. Circulation 1995; 92: 1094–1100 [DOI] [PubMed] [Google Scholar]
  • 14. Celermajer DS, Adams MR, Clarkson P, Robinson J, McCreide R, Donald A, Deanfield JE: Passive smoking and impaired endothelium‐dependent arterial dilatation in healthy young adults. N Engl J Med 1996; 334: 150–154 [DOI] [PubMed] [Google Scholar]
  • 15. Johnstone MT, Creager SJ, Scales KM, Cusco JA, Lee BK, Creager MA: Impaired endothelium‐dependent vasodilation in patients with insulin‐dependent diabetes mellitus. Circulation 1993; 88: 2510–2516 [DOI] [PubMed] [Google Scholar]
  • 16. Panza JA, Quyyumi AA, Brush JE Jr, Epstein SE: Abnormal endothelium‐dependent vascular relaxation in patients with essential hypertension. N Engl J Med 1990; 323: 22–27 [DOI] [PubMed] [Google Scholar]
  • 17. Panza JA, Casino PR, Kilcoyne CM, Quyyumi AA: Role of the endothelium‐derived nitric oxide in the abnormal endothelium‐dependent vascular relaxation in patients with essential hypertension. Circulation 1993; 87: 1468–1474 [DOI] [PubMed] [Google Scholar]
  • 18. Panza JA, Quyyumi AA, Callahan TS, Epstein SE: Effect of antihypertensive treatment of endothelium‐dependent vascular relaxation in patients with essential hypertension. J Am Coll Cardiol 1993; 21: 1145–1151 [DOI] [PubMed] [Google Scholar]
  • 19. Zeiher AM, Drexler H, Saurier B, Just H: Endothelium‐mediated coronary blood flow modulation in humans: Effect of age, atherosclerosis, hypercholesterolemia, and hypertension. J Clin Invest 1993; 92: 652–662 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE: Ageing is associated with endothelial dysfunction in healthy men years before the age‐related decline in women. J Am Coll Cardiol 1994; 24: 471–476 [DOI] [PubMed] [Google Scholar]
  • 21. Williams JK, Adams MR, Klopfenstein HS: Estrogen modulates responses of atherosclerotic coronary arteries. Circulation 1990; 81: 1680–1687 [DOI] [PubMed] [Google Scholar]
  • 22. Lieberman EH, Gerhard MD, Uehata A, Walsh BW, Selwyn AP, Ganz P, Yeung AC, Creager MA: Estrogen improves endothelium‐dependent flow‐mediated vasodilation in postmenopausal women. Ann Intern Med 1994; 121: 936–941 [DOI] [PubMed] [Google Scholar]
  • 23. Esper RJ, Vilariñio J, Cacharrón JL, Kura M, Suarez D: Endothelium‐dependent arterial responses: Influence of age, sex and atherosclerotic risk factors (abstr). J Am Coll Cardiol 1998; 31 (suppl C): 264C [Google Scholar]
  • 24. Egashira K, Hirooka Y, Kai H, Sugimachi M, Suzuki S, Inou T, Takeshita A: Reduction in serum cholesterol with pravastatin improves endothelium‐dependent vasomotion in patients with hypercholesterolemia. Circulation 1994; 89: 2519–2524 [DOI] [PubMed] [Google Scholar]
  • 25. Treasure CB, Klein JL, Weintraub WS, Talley JD, Stillabower ME, Kosisnski AS, Zhang J, Bocuzzi SJ, Cedarholm JC, Alexander W: Beneficial effects of cholesterol‐lowering therapy on the coronary endothelium in patients with coronary artery disease. N Engl J Med 1995; 332: 481–487 [DOI] [PubMed] [Google Scholar]
  • 26. Anderson TJ, Meredith IT, Yeung AC, Frei B, Selwyn AP, Ganz P: The effects of cholesterol‐lowering and antioxidant therapy on endothelium‐dependent coronary vasomotion. N Engl J Med 1995; 332: 488–493 [DOI] [PubMed] [Google Scholar]
  • 27. Levine GN, Frei B, Koulouris SN, Gerhard MN, Kearney JF Jr, Vita JA: Ascorbic acid reverses endothelial vasomotor dysfunction in patients with coronary artery disease. Circulation 1996; 93: 1107–1113 [DOI] [PubMed] [Google Scholar]
  • 28. Gilligan DM, Sack MN, Guetta V, Casino PR, Quyyumi AA, Rader DJ, Panza JA, Cannon RO: Effect of antioxidant vitamins on low density lipoprotein oxidation and impaired endothelium‐dependent vasodilation in patients with hypercholesterolemia. J Am Coll Cardiol 1994; 24: 1611–1617 [DOI] [PubMed] [Google Scholar]
  • 29. Solzbach U, Hornig B, Jeserich M, Just H: Vitamin C improves endothelial dysfunction of epicardial coronary arteries in hypertensive patients. Circulation 1997; 96: 1513–1519 [DOI] [PubMed] [Google Scholar]
  • 30. Creager MA, Gallagher SJ, Girerd XJ, Coleman SM, Dzau VJ, Cooke JP: L‐arginine improves endothelium‐dependent vasodilation in hypercholesterolemic humans. J Clin Invest 1992; 90: 1248–1253 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Drexler H, Zeiher AM, Meinertz T, Just H: Correcting endothelial dysfunction in coronary microcirculation of hypercholesterolemic patients by L‐arginine. Lancet 1991; 338: 1546–1550 [DOI] [PubMed] [Google Scholar]
  • 32. Clarkson D, Adams MR, Powe A, Donald AD, McCredie RM, Robinson J, McCarthy SN, Keech A, Celermajer DS, Deanfield JE: Oral L‐arginine improves endothelium‐dependent dilation in hypercholesterolemic young adults. J Clin Invest 1996; 97: 1989–1994 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Sorensen KE, Celermajer DS, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Thomas O, Deanfield JA: Non‐invasive measurement of human endothelium dependent arterial responses: Accuracy and reproducibility. Br Heart J 1995; 74: 247–253 [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES