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Does acute improvement of endothelial dysfunction in coronary artery disease improve myocardial ischemia?

A double-blind comparison of parenteral D- and L-Arginine

^a Cardiology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA

View larger version (17K): [in a new window]   Figure 1 Forearm blood flow and vascular resistance changes with intraarterial ACH before and after L- and D-arginine. p values represent two-way repeated measures ANOVA.

View larger version (10K): [in a new window]   Figure 2 Increase in forearm blood flow with ACH during dextrose infusion (control) and after L-arginine and D-arginine. The flow increment beyond baseline changes observed with both arginine enantiomers is shown. p values represent two-way repeated measures ANOVA.

View larger version (16K): [in a new window]   Figure 3 Changes in heart rate, mean arterial blood pressure and rate-pressure product during exercise with intravenous dextrose 5% (D5W), L-arginine or D-arginine. p values represent two way repeated measures ANOVA.

View larger version (24K): [in a new window]   Figure 4 The heart rate, mean arterial blood pressure, rate-pressure product and the duration of exercise at 1-mm ST-segment depression during treadmill exercise testing with dextrose 5% (D5W), L-arginine and D-arginine. There were no significant differences between the treatments by two-way repeated measures ANOVA.

View larger version (29K): [in a new window]   Figure 5 The increase in forearm blood flow with L-arginine and D-arginine compared to control in patients with initially "depressed" endothelial function (n = 11) is compared to responses in patients with better ("normal") endothelial function (n = 11). The rate-pressure product and duration of exercise at 1-mm ST-segment depression during exercise is also demonstrated. There was no significant difference between the groups by two-way repeated measures ANOVA. (D5W = dextrose 5%.)