Improvement of coronary vasodilatation capacity through single LDL apheresis

被引:97
作者
Mellwig, KP [1 ]
Baller, D
Gleichmann, U
Moll, D
Betker, S
Weise, R
Notohamiprodjo, G
机构
[1] Ruhr Univ Bochum, Univ Hosp, Heart & Diabet Ctr Northrhine Westphalia, Clin Cardiol, D-32545 Bad Oeynhausen, Germany
[2] Ruhr Univ Bochum, Univ Hosp, Heart & Diabet Ctr Northrhine Westphalia, Inst Mol Biophys Radiopharm & Nucl Med, D-32545 Bad Oeynhausen, Germany
关键词
hypercholesterolemia; coronary vasodilatation capacity; LDL apheresis; HELP technique; positron emission tomography;
D O I
10.1016/S0021-9150(98)00055-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A concomitant phenomenon of hypercholesterolemia is reduced coronary vasodilatation capacity due to disturbed endothelial function. Endothelial function can be partially or completely normalized by reducing cholesterol levels through drug therapy, but it is still unclear how rapidly this desired effect is achieved. An interval of between weeks and months has been presumed. LDL apheresis (LDL-A) is capable of achieving a high-degree LDL cholesterol reduction within hours. With positron emission tomography (PET), carried out immediately before and after LDL-A, changes in coronary reserve due to this abrupt LDL cholesterol reduction could be measured both quantitatively and non-invasively. In nine patients (six women, three men) with documented coronary artery disease and hypercholesterolemia, PET was carried out immediately before and 18-20 h after LDL-A. A reduction in LDL cholesterol (from 194 +/- 38 to 81 +/- 20 mg/dl), facilitated significant improvement in myocardial blood flow (MBF) (173 +/- 63 versus 226 +/- 79 ml/min per 100 g) after pharmacologic recruitment of coronary flow capacity (dipyridamole stress), coronary flow reserve (CFR) (1.91 +/- 0.68 versus 2.48 +/- 0.68) and minimum coronary resistance (MCR) (0.61 +/- 0.18 versus 0.43 +/- 0.16 mmHg/100 g per min per ml) within 24 h. Plasma viscosity was reduced slightly, by 6.6%. Probably for the first time, a 30% improvement in coronary vasodilatation capacity could be demonstrated quantitatively and non-invasively by PET after a single LDL-A within 24 h. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.
引用
收藏
页码:173 / 178
页数:6
相关论文
共 21 条
[1]   THE EFFECT OF CHOLESTEROL-LOWERING AND ANTIOXIDANT THERAPY ON ENDOTHELIUM-DEPENDENT CORONARY VASOMOTION [J].
ANDERSON, TJ ;
MEREDITH, IT ;
YEUNG, AC ;
FREI, B ;
SELWYN, AP ;
GANZ, P .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (08) :488-493
[2]   A CRITICAL-LOOK AT CURRENTLY USED INDIRECT INDEXES OF MYOCARDIAL OXYGEN-CONSUMPTION [J].
BALLER, D ;
BRETSCHNEIDER, HJ ;
HELLIGE, G .
BASIC RESEARCH IN CARDIOLOGY, 1981, 76 (02) :163-181
[3]  
BALLER D, 1997, NUKLEARMEDIZINJ, V36, pV134
[4]  
BALLER D, 1997, NUKLEARMEDIZINJ, V36, pA48
[5]   LIPID-LOWERING AND PLAQUE REGRESSION - NEW INSIGHTS INTO PREVENTION OF PLAQUE DISRUPTION AND CLINICAL EVENTS IN CORONARY-DISEASE [J].
BROWN, BG ;
ZHAO, XQ ;
SACCO, DE ;
ALBERS, JJ .
CIRCULATION, 1993, 87 (06) :1781-1791
[6]   SHORT-TERM CHOLESTEROL-LOWERING DECREASES SIZE AND SEVERITY OF PERFUSION ABNORMALITIES BY POSITRON EMISSION TOMOGRAPHY AFTER DIPYRIDAMOLE IN PATIENTS WITH CORONARY-ARTERY DISEASE - A POTENTIAL NONINVASIVE MARKER OF HEALING CORONARY ENDOTHELIUM [J].
GOULD, KL ;
MARTUCCI, JP ;
GOLDBERG, DI ;
HESS, MJ ;
EDENS, RP ;
LATIFI, R ;
DUDRICK, SJ .
CIRCULATION, 1994, 89 (04) :1530-1538
[7]  
HOLTZ J, 1991, EUR HEART J SUPPL, V12, P525
[8]  
Hutchins G D, 1993, Am J Card Imaging, V7, P283
[9]   NONINVASIVE QUANTIFICATION OF REGIONAL BLOOD-FLOW IN THE HUMAN HEART USING N-13 AMMONIA AND DYNAMIC POSITRON EMISSION TOMOGRAPHIC IMAGING [J].
HUTCHINS, GD ;
SCHWAIGER, M ;
ROSENSPIRE, KC ;
KRIVOKAPICH, J ;
SCHELBERT, H ;
KUHL, DE .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1990, 15 (05) :1032-1042
[10]   ACUTE EFFECTS OF EXTRACORPOREAL ELIMINATION OF LOW-DENSITY LIPOPROTEIN (LDL) CHOLESTEROL AND FIBRINOGEN ON BLOOD RHEOLOGY AND MICROCIRCULATION [J].
KLEOPHAS, W ;
LESCHKE, M ;
TSCHOPE, D ;
MARTIN, J ;
SCHAUSEIL, S ;
SCHOTTENFELD, Y ;
STRAUER, BE ;
GRIES, FA .
DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT, 1990, 115 (01) :3-7