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CLINICAL STUDIES

Acute effects of urinary bladder distention on the coronary circulation in patients with early atherosclerosis

Tsung-Ming Lee, MD, FESC^*, Sheng-Fang Su, PhD, Ming-Fong Chen, MD, PhD, FACC, FESC^* and Chang-Her Tsai, MD, PhD

^* Department of Internal Medicine, Cardiology Section, National Taiwan University Hospital, Taipei, Taiwan
Department of Surgery, Cardiology Section, National Taiwan University Hospital, Taipei, Taiwan
College of Medicine, National Cheng Kung University, Tainan, Taiwan

Manuscript received October 22, 1999; revised manuscript received February 16, 2000, accepted April 5, 2000.

Reprint requests and correspondence: Dr. Chang-Her Tsai, Department of Surgery, Cardiology Section, National Taiwan University Hospital, 7, Chung-Shan S. Road, Taipei, Taiwan 10002
tsaicher{at}ha.mc.ntu.edu.tw

OBJECTIVES

We sought to examine whether distention of the urinary bladder, a physiologic stimulus, could induce impaired coronary circulation in patients with early atherosclerosis.

BACKGROUND

Distention of the urinary bladder reflexively causes an increase in sympathetic activity. The effect of such distention on the coronary circulation in patients with early atherosclerosis remains unknown.

METHODS

To assess the effect of bladder distention on coronary dynamic forces, epicardial and microvascular responses were measured with an intracoronary Doppler flow wire in 40 patients with early atherosclerosis (<50% diameter stenosis). Patients were randomized into two groups according to whether they did not (group 1, n = 20) or did have (group 2, n = 20) pretreatment with an alpha₁-adrenergic receptor blocker (oral doxazosin, 2 mg). Coronary flow velocity was monitored by quantitative coronary angiography at baseline, during urinary bladder distention and after intracoronary nitroglycerin injection.

RESULTS

Bladder distention significantly decreased the coronary diameter in the stenotic segments (p < 0.001), decreased coronary blood flow (p < 0.001) and increased coronary resistance (p < 0.001), as compared with baseline values, in group 1 patients. In group 2 patients with bladder distention, the angiographic variables did not show significant changes, as compared with baseline values. No significant differences were noted between the groups in the responses of the angiographic variables after nitroglycerin administration.

CONCLUSIONS

The present study shows, for the first time, that urinary bladder distention caused vasoconstriction of coronary conduit and resistance vessels involved mechanisms related to alpha₁ adrenoceptors. Pretreated administration of doxazosin reversed the changes toward baseline. Vasoconstriction during bladder distention can be relieved after nitroglycerin administration, suggesting an unchanged responsiveness of vascular smooth muscle cells to such distention.

Abbreviations and Acronyms   APV = average peak velocity   CBF = coronary blood flow   CSA = cross-sectional area   ECG = electrocardiogram or electrocardiographic   MLE = myocardial lactate extraction

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