Catecholamines in Patients with Coronary Heart Disease

Abstract

Circulating catecholamines have been investigated in different vascular beds of patients with coronary heart disease (CHD), patients with congestive heart failure (CHF) and the respective control subjects (C). In 20 patients with CHD, 13 patients with CHF and 9 subjects without angiographic evidence of CHD or CHF noradrenaline (NA) concentrations were radioenzymatically assayed in samples obtained from a peripheral vein (PV), aorta (AO) and coronary sinus (CS) at rest and during physical exercise on an ergometric bicycle. At rest in patients with CHD and CHF significantly increased NA concentrations (pg/ml) could be observed in all vascular beds(C: PV=216±56, AO = 166±37,CS = 217±69; CHD: PV=451±48, AO) = 449±66,CS = 530± 102; CHF: PV = 761±230,AO) = 632± 102,CS = 750± 178). During exercise the increase in NA concentration in CS exceeded the increase in AO, indicating a release of NA by the myocardium. The release of NA by the myocardium was significantly increased in patients with CHD and CHF versus C (CS: Δ971 ± 151 pg/ml and CS: Δ2239 ± 447 pg/ml, respectively). A positive correlation between coronary score and circulating NA in CS during physical exercise could be observed (r=0.56). There was an inverse relationship between ejection fraction and circulating NA in coronary sinus at rest and during exercise (r=−0.62 and r=−0.70). In another group of 11 patients with CHD changes in arterial and coronary sinus NA and adrenaline concentrations were measured before and after incremental pacing of the right atrium and graded physical exercise. Also in these patients with CHD, resting NA levels in brachial artery (318 ±39 pg/ml) and CS (417 ±72 pg/ml) were increased. In addition increased adrenaline levels in brachial artery (117 ±28 pg/ml and CS 99 ± 19 pg/ml) were assayed. Whereas after pacing no further liberation of NA by the myocardium was observed, during physical exercise a significant release of NA by the myocardium occurred (100 Watt: ΔNA in CS: 1066 pg/ml). In contrast to a positive arterial coronary venous NA difference (AVD), a negative AVD for adrenaline at rest and during electric stimulation was measured, indicating an uptake of adrenaline by the heart. The uptake of adrenaline was blunted during physical exercise.