Beta-endorphins during coronary angioplasty in patients with silent or symptomatic myocardial ischemia

Department of Internal Medicine, University Hospital, Pavia, Italy.

OBJECTIVES. The aims of this study were to correlate beta-endorphin plasma levels and anginal pain in patients with ischemia induced by percutaneous transluminal coronary angioplasty and to detect eventual endorphin variations during balloon occlusion. BACKGROUND. The opioid system appears involved in the absence of pain occurring in silent myocardial ischemia. METHODS. Beta-endorphin plasma levels were measured 24 h before, just before, during and after coronary angioplasty (performed on the left anterior descending artery) in 53 men with documented coronary artery disease and exercise-induced myocardial ischemia. RESULTS. Group 1 (33 patients) reported symptoms; group 2 (20 patients) was asymptomatic during angioplasty. In these patients, the prevalence of exercise-induced silent ischemia was 57%. The occurrence of angina during exercise or angioplasty was related to the frequency of angina during daily life when patients were subgrouped. The severity and distribution of coronary artery disease did not differ between the two groups. During angioplasty, the number of balloon inflations and the inflation time and pressure were similar in symptomatic and asymptomatic patients. In each group, no short-term variability of baseline beta-endorphin plasma levels was observed during 2 consecutive days. Corresponding beta-endorphin plasma levels (at baseline and during and after angioplasty) were significantly higher in Group 2. During balloon occlusion, the levels decreased significantly in the symptomatic group at the onset of angina but remained stable in the asymptomatic group. CONCLUSIONS. Methodologic variables and the severity of coronary artery disease did not influence the presence of symptoms during angioplasty-induced ischemia. Beta-endorphin plasma levels were higher and more stable in patients with silent ischemia during angioplasty, suggesting that opiate levels and their variation during ischemia are associated with individual attitude toward anginal pain.

This article has been cited by other articles:

				M. Dweck, D. Miller, I. W Campbell, and C M. Francis Review: Mechanisms of silent myocardial ischaemia: with particular reference to diabetes mellitus The British Journal of Diabetes & Vascular Disease, May 1, 2009; 9(3): 99 - 102. [Abstract] [PDF]

				P. F. Cohn, K. M. Fox, and C. Daly Silent Myocardial Ischemia Circulation, September 9, 2003; 108(10): 1263 - 1277. [Full Text] [PDF]

				A. Mazzone, C. Cusa, I. Mazzucchelli, M. Vezzoli, E. Ottini, R. Pacifici, P. Zuccaro, and C. Falcone Increased production of inflammatory cytokines in patients with silent myocardial ischemia J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1895 - 1901. [Abstract] [Full Text] [PDF]

				R. Schulz, P. Gres, and G. Heusch Role of endogenous opioids in ischemic preconditioning but not in short-term hibernation in pigs Am J Physiol Heart Circ Physiol, May 1, 2001; 280(5): H2175 - H2181. [Abstract] [Full Text] [PDF]

				A. Mazzone, I. Mazzucchelli, M. Vezzoli, E. Ottini, C. Auguadro, A. Serio, and C. Falcone Increased expression of peripheral benzodiazepine receptors on leukocytes in silent myocardial ischemia J. Am. Coll. Cardiol., September 1, 2000; 36(3): 746 - 750. [Abstract] [Full Text] [PDF]

				D. S. Sheps, R. P. McMahon, K. C. Light, W. Maixner, C. J. Pepine, J. D. Cohen, A. D. Goldberg, R. Bonsall, R. Carney, P. H. Stone, et al. Low hot pain threshold predicts shorter time to exercise-induced angina: results from the psychophysiological investigations of myocardial ischemia (PIMI) study J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1855 - 1862. [Abstract] [Full Text] [PDF]

				C. Falcone, C. Auguadro, R. Sconocchia, and L. Angoli Susceptibility to Pain in Hypertensive and Normotensive Patients With Coronary Artery Disease : Response to Dental Pulp Stimulation Hypertension, November 1, 1997; 30(5): 1279 - 1283. [Abstract] [Full Text]