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CLINICAL STUDIES

Increased release of nitric oxide in ischemic hearts after exercise in patients with effort angina

^a First Department of Medicine, Osaka University School of Medicine, Suita, Japan
^b First Department of Physiology, Osaka University School of Medicine, Suita, Japan

Manuscript received October 3, 1996; revised manuscript received March 11, 1998, accepted March 20, 1998.

Address for correspondence: Dr. Masafumi Kitakaze, First Department of Medicine, Osaka University School of Medicine, 2-2 Yamadaoka, Suita 565–0871, Japan

Objectives. The aim of this study was to determine whether the release of nitric oxide (NO) from the ischemic heart increases during exercise in patients with effort angina.

Background. Myocardial ischemia increases NO production in the canine heart, but no such increase has been demonstrated in the ischemic human heart.

Methods. Fifteen patients with effort angina underwent supine ergometer exercise tests. All patients had severe proximal stenosis (>90%) in the left anterior descending coronary artery. The control group consisted of 17 subjects without coronary artery disease or systemic hemodynamic abnormalities.

Results. Neither the lactate extraction ratio (LER) nor the difference in NO concentration between coronary venous and arterial blood (VA[NO]) was affected by exercise in the control subjects. In patients with effort angina, neither variable differed from that in the control group at rest; however, exercise markedly decreased LER and significantly increased VA(NO) (from 4.7 ± 0.3 to 16.5 ± 1.6 µmol/liter, p < 0.001) in the patient group. The extent of decrease in LER was significantly correlated with the extent of increase in VA(NO) in the patients with effort angina (r² = –0.837, p < 0.001).

Conclusions. Provocation of myocardial ischemia by exercise stress increases NO production in the hearts of patients with effort angina.

Abbreviations and Acronyms   CAD = coronary artery disease   ECG = electrocardiogram, electrocardiographic   LAD = left anterior descending coronary artery   LER = lactate extraction ratio   NO = nitric oxide   VA(NO) = difference in nitric oxide concentration between coronary venous and arterial blood

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