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Improvement of coronary artery endothelial dysfunction with lipid-lowering therapy: heterogeneity of segmental response and correlation with plasma-oxidized low density lipoprotein

William F. Penny, MD, FACC^*, Ori Ben-Yehuda, MD, Kenji Kuroe, MA, John Long, PhD^* , Alan Bond, PhD^* , Valmik Bhargava, PhD, FACC^*, Joseph F. Peterson, MD^* , Martin McDaniel, BA, Joseph Juliano, BS, Joseph L. Witztum, MD, John Ross, Jr., MD, FACC and Kirk L. Peterson, MD, FACC

^* University of California, San Diego, California, USA
Veterans Administration Medical Center, San Diego, California, USA

View larger version (111K): [in a new window]   Figure 1 Composite image of a left anterior descending coronary artery. Algorithm-derived edges, the calculated vessel centerline, vessel segments and sequential diameters are displayed. Branch points are used for interpolation of diameters (6). pt = point.

View larger version (15K): [in a new window]   Figure 2 Changes in vessel dimension and vasomotor response to successive Ach infusions are shown as the average of per patient means (n = 29). (A) Plot of mean vessel diameter in mm at control and after Ach infused at 10–6 to 10–4M. Baseline values (M ± SE) are shown as closed circles/solid line; values from follow-up study after cholesterol lowering are shown as open squares/dashed line. (B) Plot of mean change (in mm) in vessel diameter from control upon Ach infusion at graded doses (M ± SE). (C) Plot of mean percent change in vessel diameter from control upon Ach infusion at graded doses (M ± SE). Ach = acetylcholine. Solid circle = baseline; Shaded square = follow-up.

View larger version (30K): [in a new window]   Figure 3 Heterogeneity of vasomotor response after cholesterol lowering demonstrated as the interval change of response of all segments to Ach 10–4M grouped by patient number. See text for further discussion. Ach = acetylcholine.

View larger version (28K): [in a new window]   Figure 4 Plot of percentage change in segment diameter versus control (vertical axis) ranked by decile from the most constricted to the most dilated (horizontal axis). Data for infusion of Ach 10–4M presented. Note that the most constricted segments improved after lipid lowering while those that dilated showed less dilation or mild constriction. See text for discussion. Ach = acetylcholine. Open square = prelipid-lowering; closed circle = postlipid-lowering.