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      Norepinephrine Elicits β 2 -Receptor–Mediated Dilation of Isolated Human Coronary Arterioles

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          Abstract

          Background The exact role of adrenoceptors in norepinephrine (NE)-mediated regulation of the human coronary circulation has yet to be elucidated. Thus, the goals of this study were to characterize the adrenoceptors involved in the responses to NE in isolated human coronary arterioles and small arteries.

          Methods and Results Arterioles (n=39) and small arteries from the left ventricle of explanted human hearts were isolated and cannulated. Vessels from the hearts of 21 patients were studied: 15 males and 6 females, aged 0.5 to 63 years. Nineteen patients were considered to be New York Heart Association class 4. All hearts exhibited hypertrophy (190±20%). The passive diameter of arterioles was 167±8 μm (range 97 to 323 μm). NE (10 −7 to 3×10 − 7 mol/L) elicited concentration-dependent dilations (47±4 μm) that were unaffected by endothelium removal, N ω -nitro- l -arginine (10 − 4 mol/L, an NO synthase inhibitor), or practolol (10 −6 mol/L, a β 1 -receptor blocker). However, administration of propranolol (10 −5 mol/L, a combined β 1 - and β 2 -blocker) or butoxamine (10 −6 mol/L, a β 2 -receptor blocker) completely eliminated the NE-induced dilation. Constrictions to NE (2 of 39 vessels) were inhibited by prazosin (10 −6 mol/L, an α 1 -receptor blocker). Methoxamine (10 − 9 to 10 −5 mol/L, an α 1 -agonist) had no effect, whereas U44619, a thromboxane mimetic, elicited dose-dependent constriction of vessels.

          Conclusions Our data indicate that isolated human coronary arterioles and small arteries dilate to NE via β 2 -receptors on smooth muscle. These findings are important to our understanding of the mechanisms action of NE in the human coronary circulation.

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          Most cited references15

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          Reflex increase in coronary vascular resistance in patients with ischemic heart disease.

          To assess possible coronary vasoconstriction in patients with ischemic heart disease, we measured coronary vascular resistance in 12 patients with normal hearts and 12 with coronary disease before and during the initial 50 seconds of cold pressor test, a stimulus known to produce systemic vasoconstriction. Control coronary vascular resistance was similar in the two groups, and although it did not change in patients with normal vessels, it rose by 27 per cent (P less than 0.005) in the group with coronary disease during the cold pressor test. In three of 12 patients with coronary disease coronary flow actually declined despite an increase in arterial pressure; in four, angina was precipitated. Phentolamine abolished increases in arterial pressure and coronary vascular resistance during the test in three patients with coronary disease. Adrenergically mediated coronary vascular tone may be an important determinant of coronary blood flow and may contribute to ischemia in patients with coronary disease.
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            Feedforward sympathetic coronary vasodilation in exercising dogs.

            The hypothesis that exercise-induced coronary vasodilation is a result of sympathetic activation of coronary smooth muscle beta-adrenoceptors was tested. Ten dogs were chronically instrumented with a flow transducer on the circumflex coronary artery and catheters in the aorta and coronary sinus. During treadmill exercise, coronary venous oxygen tension decreased with increasing myocardial oxygen consumption, indicating an imperfect match between myocardial blood flow and oxygen consumption. This match was improved after alpha-adrenoceptor blockade with phentolamine but was significantly worse than control after alpha + beta-adrenoceptor blockade with phentolamine plus propranolol. The response after alpha-adrenoceptor blockade included local metabolic vasodilation plus a beta-adrenoceptor vasodilator component, whereas the response after alpha + beta-adrenoceptor blockade contained only the local metabolic vasodilator component. The large difference in coronary venous oxygen tensions during exercise between alpha-adrenoceptor blockade and alpha + beta-adrenoceptor blockade indicates that there is significant feedforward beta-adrenoceptor coronary vasodilation in exercising dogs. Coronary venous and estimated myocardial interstitial adenosine concentrations did not increase during exercise before or after alpha + beta-adrenoceptor blockade, indicating that adenosine levels did not increase to compensate for the loss of feedforward beta-adrenoceptor-mediated coronary vasodilation. These results indicate a meaningful role for feedforward beta-receptor-mediated sympathetic coronary vasodilation during exercise.
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              Neural Control of Coronary Blood Flow

              Eric Feigl (1998)
              Parasympathetic control of coronary blood flow has been extensively studied in dogs, and a clear vasodilator effect not dependent on changes in myocardial metabolism was observed. Parasympathetic vasodilatation is mediated via nitric oxide (EDRF) and is activated during carotid baroreceptor and chemoreceptor reflexes. Intracoronary infusions of acetylcholine in humans results in increased coronary blood flow and epicardial coronary artery dilatation except in atherosclerotic epicardial coronary vessels, which show a paradoxical vasoconstriction. Sympathetic α-adrenoceptor-mediated coronary vasoconstriction has been repeatedly demonstrated whenever there is adrenergic activation of the heart, as during exercise or a carotid sinus baroreceptor reflex in dogs or during a cold pressor reflex in humans. Recent evidence indicates that there is a beneficial effect of this paradoxical vasoconstrictor influence in that it helps preserve flow to the vulnerable inner layer of the left ventricle, but only when both heart rate and coronary flow are high. β-Adrenoceptor-mediated coronary vasodilatation also occurs during adrenergic activation of the heart. The dominant site for β-vasodilatation is in small arterioles, while the dominant site for α-vasoconstriction is in microvessels larger than ∼100 µm diameter. The β-adrenoceptor coronary vasodilatation is an example of feedforward open-loop control that complements the closed-loop negative feedback control by local metabolic factors. The combined feedback and feedforward control mechanism has the advantage of an excellent match between coronary blood flow and myocardial oxygen consumption with a rapid response time but without the instability inherent in high gain feedback systems.
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                Author and article information

                Journal
                Circulation
                Circulation
                Ovid Technologies (Wolters Kluwer Health)
                0009-7322
                1524-4539
                July 30 2002
                July 30 2002
                : 106
                : 5
                : 550-555
                Affiliations
                [1 ]From the Department of Physiology (D.S., A.H., A.K., T.H.H., G.K.), New York Medical College, Valhalla, and the Department of Surgery (S.M., M.R.K., C.C.M., L.J.A., R.E.M.), Division of Cardiothoracic Surgery and the Transplant Service, Columbia University, College of Physicians and Surgeons, New York, NY. Dr Kichuk is now at The Cleveland Clinic, Cleveland, Ohio, and Dr Michler is now at Ohio University Medical Center, Columbus.
                Article
                10.1161/01.CIR.0000023896.70583.9F
                2c6378a0-f0fd-49b9-a683-5f353ddda4b6
                © 2002
                History

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