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Effects of bradykinin on coronary blood flow and vasomotion in transplant patients

Eduardo Aptecar, MD^* , Emmanuel Teiger, MD^* , Patrick Dupouy, MD^* , Christophe Benvenuti, MD, Morton J. Kern, MD, Javier Woscoboinik, MD, Said Sediame, MD, Jean Marc Pernes, MD, Alain Castaigne, MD^*, Daniel Loisance, MD and Jean-Luc Dubois-Randé, MD^*

^* Fédération de Cardiologie et Institut National de la Santé et de la Recherche Médicale U400, Créteil, France
Unité d’Hémodynamique et de Cardiologie Interventionnelle, Service des Explorations Fonctionnelles, Créteil, France
Service de Chirurgie Thoracique et Cardio-vasculaire et Centre National de la Recherche Scientifique URA 1431, Hôpital Henri Mondor, Créteil, France
St. Louis University Hospital, St. Louis, Missouri, USA

View larger version (15K): [in a new window]   Figure 1 Plots show changes in coronary epicardial diameter, average peak velocity (APV) and calculated coronary blood flow, all expressed as the percent of baseline (mean ± SD) in response to increasing doses of bradykinin and acetylcholine, and to 1mg of linsidomine (Sin-1). BK 1, 2 and 3: bradykinin in doses of 50, 150 and 250 ng/min. ACh 1, 2 and 3: acetylcholine at estimated coronary blood concentrations of 10-8, 10-7 and 10-6 M. p < 0.0001 transplant patients versus control subjects.

View larger version (152K): [in a new window]   Figure 2 Four left coronary artery cineangiographic frames in right anterior oblique view from a single transplant patient are displayed. As compared with baseline (top left), marked epicardial vasodilation was observed at the peak of the highest bradykinin infusion dose (BK, 250 ng/min) (top right) as well as 3 min after a 1-mg intracoronary bolus of linsidomine (Sin-1) (bottom right). On the contrary, marked epicardial vasoconstriction occurred at the peak of the highest acetylcholine infusion dose (ACh, 10-6 M) (bottom left). The simultaneous recording of coronary blood flow velocity with the corresponding value of the average peak velocity (APV) is shown under each angiographic frame.

View larger version (18K): [in a new window]   Figure 3 Effects of bradykinin (BK) and acetylcholine (ACh) on coronary blood flow in eight transplant patients with and eight without allograft rejection (grades 2 and 3 of the ISHLT classification). Rejection did not impair the dose-dependent increase in coronary blood flow induced by bradykinin. On the contrary, the acetylcholine-induced increase in coronary blood flow was significantly lower (*p < 0.05) in the presence of rejection. Open circles = no rejection; black circles = rejection.