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Biomedical subjects

A Lupi

Publications and source records attributed to A Lupi.

At least 37 records · Page 2Linked to original sources
PubMed2001

[False mass in the left atrium... or better: true mass in false atrium].

We report the case of a 59-year-old man who underwent transesophageal echocardiography following a cryptogenic minor stroke. An image of a solid mass of the left atrial appendage, highly suggestive of a thrombus, was observed. The patient was treated for 10 weeks with oral anticoagulants. Because of the absence of changes in the echocardiographic appearance of the mass at follow-up, the patient was submitted to surgery. At surgical exploration no endocavitary thrombus was found, but the left atrial appendage appeared hypoplastic and dysmorphic. A biopsy was taken and the left atrial appendage was plicated. To our knowledge, this is the first report of a case of dysmorphism of the left atrial appendage mimicking a left atrial thrombus in a patient with cryptogenic minor stroke.

Atrial Appendage↗
PubMed2000

Separation of closely related peptide substrates of human proteinases by micellar electrokinetic chromatography with anionic and nonionic surfactants.

In order to use micellar electrokinetic chromatography to determine the proteolytic activity of different proteinases simultaneously present in physiological fluids, the technique must be able to separate mixtures of substrates with closely related structures. In an attempt to determine the best electrophoretic conditions for resolving six p-nitroanilide peptides used as synthetic substrates of the elastolytic enzymes (human neutrophil elastase, cathepsin G, Pseudomonas aeruginosa elastase) most commonly involved in pulmonary diseases, we investigated the efficiency of ionic and nonionic surfactants in achieving the separation of this complex mixture. The results presented here show that, of all the electrophoretic systems tested, 30 mM sodium tetraborate, pH 9.3, containing 25 mM Brij 35 as micellar agent offered the best performance; the separation efficiency of peptides is greater than that obtained with other reagents and all peaks are baseline resolved and unambiguously identifiable. Analysis of the micelle-solute interaction with the surfactants investigated allowed better definition of the mechanism involved in the distribution of these peptides to the micelles and identification of some structural features that determined the magnitude of the micelle peptide complex formation.

Cathepsin G↗
PubMed2000

Alpha1-antitrypsin in serum determined by capillary isoelectric focusing.

A capillary isoelectric focusing (CIEF) method using bare fused-silica capillaries filled with polyethylene oxide (PEO) and carrier ampholyte solutions in the pH 3.5-5.0 range has been developed for the identification of alpha1-antitrypsin (alpha1AT) phenotypes in human serum. This novel procedure was routinely applied to the study of serum samples of five controls whose alpha1AT phenotype was previously identified and of twelve subjects whose alpha1AT phenotype was unknown. The results obtained allowed us to confirm or identify the alpha1AT phenotype in all sera tested. This procedure seems particularly suitable for identification of alpha1AT variants associated with diseases of clinical relevance.

Chromatography, High Pressure Liquid↗
PubMed2000

MEKC of desmosine and isodesmosine in urine of chronic destructive lung disease patients.

Degradation of extracellular matrix components is central to many pathological features of chronic destructive lung disorders. Desmosine and isodesmosine are elastin-derived cross-linked amino acids whose urine levels are considered representative of elastin breakdown. The aim of this study was to apply a novel methodology, based on high-performance capillary electrophoresis, to the quantification of desmosine and isodesmosine in 11 patients with stable chronic obstructive pulmonary disease (COPD), 10 with an exacerbation of COPD, nine with alpha1-antitrypsin deficiency, 13 with bronchiectasis, and 11 adults with cystic fibrosis, in comparison to 24 controls. It was found that, in patients with stable COPD, urinary desmosine levels were higher than in controls (p=0.03), but lower than in COPD subjects with an exacerbation (p< or =0.05). The highest desmosine levels were found in subjects with alpha1-antitrypsin deficiency, bronchiectasis and cystic fibrosis (p<0.001 versus stable COPD). In a short-term longitudinal study, five stable COPD patients showed a constant rate of desmosine excretion (mean coefficient of variation <8% over three consecutive days). In conclusion, the present method is simple and suitable for the determination of elastin-derived cross-linked amino acid excretion in urine, giving results similar to those obtained using other separation methods. In addition, evidence is presented that urinary desmosine excretion is increased in conditions characterized by airway inflammation, such as exacerbations of chronic obstructive pulmonary disease, bronchiectasis and cystic fibrosis. Results obtained in subjects with alphal-antitrypsin deficiency suggest that this method might be used to evaluate the putative efficacy of replacement therapy.

Adult↗
PubMed2000

Effects of a reduced inner diameter of hollow fibers in hemodialyzers.

BACKGROUND: The clearance of middle molecules in high-flux hemodialyzers is due to the higher contribution of convection in the overall solute transport. Although net filtration can be maintained low by the machine control, internal filtration in the proximal part of the dialyzer remains high. The final fluid balance is achieved by significant amounts of backfiltration in the distal part of the dialyzer. To increase further middle molecule clearance (MMK), hemodiafiltration has been used. This technique, however, requires complex machines and large amounts of substitution fluid. We present a novel solution to increase the convective transport of middle molecules in high flux dialyzers without the need for substitution fluids. In particular, high-flux dialyzers with a reduced hollow fiber diameter are compared with standard dialyzers in terms of internal filtration and solute clearances. METHODS: Hemodialyzers with 175 micro inner diameter polysulfone fibers were compared with standard 200 micro polysulfone hollow fiber dialyzers. The study was carried out in vitro using a previously published method to measure internal filtration and backfiltration rates. The method is based on the detection by a gamma camera of segmental variations in concentration along the length of the dialyzer of a nondiffusable Tc99-labeled marker molecule injected in the blood in vitro circuit. At the same time, pressures were detected in the blood and dialysate compartment. The system was operated at zero net filtration maintaining volumetrically constant both dialysate and blood circuits. In vivo clearances were also measured for solutes with different molecular weight. RESULTS: The pressure drop in the blood compartment at 300 mL/min of blood flow passed from 112 to 159 mm Hg. At the same blood flow, the internal filtration-backfiltration rates increased from 23. 1 to 48.2 mL/min. This resulted in a significant increase of in vivo in clearances of vitamin B12 and inulin of more than 30%. Urea, creatinine, and phosphate clearance did not display any change. CONCLUSIONS: A reduction of the inner diameter of the hollow fibers in high-flux dialyzers may result in a significant increase of the blood compartment resistance. In turn, this results in increased rates of internal filtration and backfiltration. The practical effect in clinical dialysis is demonstrated on middle molecules. While, in fact, the clearances for small solutes such as urea and creatinine are not affected, the clearances of larger solutes such as vitamin B12 or inulin increase significantly (P < 0.01).

Biocompatible Materials↗
PubMed2000

Midterm endothelial function and remodeling of radial artery grafts anastomosed to the aorta.

BACKGROUND: The purpose of this study was to elucidate the midterm endothelium-dependent vasodilatory capacity of radial artery grafts anastomosed to the aorta, as well as their morphometric evolution with the time. METHODS: Five years after surgery we evaluated the response of aorta-anastomosed radial artery grafts to the endovascular infusion of acetylcholine in 11 of the first 61 patients operated on at our institution, and we compared it to the response with that of internal thoracic artery grafts. Moreover, the first 20 patients who had a perfect radial artery graft on angiography at 1 year were restudied at 5 years and subjected to a comparative analysis of the diameters of the radial artery graft and the grafted coronary arteries. RESULTS: At midterm angiography, dilation of the 2 types of grafts was similar in response to acetylcholine administration (radial artery, from 2.61 +/- 0.39 to 2. 90 +/- 0.34 mm; internal thoracic artery, from 2.68 +/- 0.21 to 2.93 +/- 0.27 mm; P =.01 for both). The diameters of aorta-anastomosed radial artery grafts and grafted coronary arteries increased between both 1 and 5 years according to angiographic studies (radial artery grafts, from 2.08 +/- 0.45 to 2.54 +/- 0.53 mm; grafted coronary arteries, from 1.92 +/- 0.47 to 2.18 +/- 0.41 mm; P <.001 for both), but the increase was greater for the radial artery grafts (P <.001). CONCLUSIONS: Aorta-anastomosed radial artery grafts maintain an appreciable capacity for endothelium-dependent vasodilatation 5 years after implantation and undergo a progressive increase in luminal diameter with time. These observations contradict the presumed tendency for progressive fibrous intimal hyperplasia to develop in radial artery grafts.

Acetylcholine↗
PubMed2000

Direct NAD(P)H hydrolysis into ADP-ribose(P) and nicotinamide induced by reactive oxygen species: a new mechanism of oxygen radical toxicity.

The effect of different oxygen radical-generating systems on NAD(P)H was determined by incubating the reduced forms of the pyridine coenzymes with either Fe2+-H2O2 or Fe3+-ascorbate and by analyzing the reaction mixtures using a HPLC separation of adenine nucleotide derivatives. The effect of the azo-initiator 2,2'-azobis(2-methylpropionamidine)dihydrochloride was also tested. Results showed that, whilst all the three free radical-producing systems induced, with different extent, the oxidation of NAD(P)H to NAD(P)+, only Fe2+-H2O2 also caused the formation of equimolar amounts of ADP-ribose(P) and nicotinamide. Dose-dependent experiments, with increasing Fe2+ iron (concentration range 3-180 microM) or H2O2 (concentration range 50-1000 microM), were carried out at pH 6.5 in 50 mM ammonium acetate. NAD(P)+, ADP-ribose(P) and nicotinamide formation increased by increasing the amount of hydroxyl radicals produced in the medium. Under such incubation conditions NAD(P)+/ADP-ribose(P) ratio was about 4 at any Fe2+ or H2O2 concentration. By varying pH to 2.0, 3.0, 4.0, 4.5, 5.0, 5.5, 6.0, 7.0 and 7.4, NAD(P)+/ADP-ribose(P) ratio changed to 5.5, 3.2, 1.8, 1.6, 2.0, 2.5, 3.0, 5.4 and 6.5, respectively. Kinetic experiments indicated that 90-95% of all compounds were generated within 5s from the beginning of the Fenton reaction. Inhibition of ADP-ribose(P), nicotinamide and NAD(P)+ production of Fe2+-H2O2-treated NAD(P)H samples, was achieved by adding mannitol (10-50 mM) to the reaction mixture. Differently, selective and total inhibition of ADP-ribose(P) and nicotinamide formation was obtained by performing the Fenton reaction in an almost completely anhydrous medium, i.e. in HPLC-grade methanol. Experiments carried out in isolated postischemic rat hearts perfused with 50 mM mannitol, showed that, with respect to values of control hearts, this hydroxyl radical scavenger prevented reperfusion-associated pyridine coenzyme depletion and ADP-ribose formation. On the basis of these results, a possible mechanism of action of ADP-ribose(P) and nicotinamide generation through the interaction between NAD(P)H and hydroxyl radical (which does not involve the C-center where "conventional" oxidation occurs) is presented. The implication of this phenomenon in the pyridine coenzyme depletion observed in postischemic tissues is also discussed.

Adenosine Diphosphate Ribose↗
PubMed1999

Micellar electrokinetic chromatography for analyzing active site specificity of Pseudomonas aeruginosa elastase.

The geometry of the catalytic site of Pseudomonas aeruginosa elastase was reexamined, exploiting the specific feature of micellar electrokinetic chromatography (MEKC), i.e., its ability to detect a decrease of intact substrate and simultaneous formation of reaction products. We carried out a detailed investigation using two tri- and six tetra-peptide 4-nitroanilides (NA) differing from each other by only one or more amino acids as stable substrates. The kinetic cleavage parameters Km and k(cat) determined by MEKC and the catalytic efficiency Km/k(cat) values calculated allowed us to better define the substrate specificity of this proteinase.

Amino Acids↗
PubMed1999

Dopamine denervation of specific striatal subregions differentially affects preparation and execution of a delayed response task in the rat.

In the present study, the effects of unilateral or bilateral dopamine denervation of either the dorsal or ventral striatum on the preparation and execution of a delayed response task in the rat were investigated. Animals were instructed to hold a lever pressed down by the presentation of a visual and/or acoustic signal, and were required to hold the lever until a trigger stimulus occurred after an unpredictable delay ranging from 2 to 4 s. The trigger stimulus required animals to release the lever and to press a second lever for food reinforcement. The time between instruction and trigger signal represented the preparation phase preceding movement. The motor performance was evaluated by using reaction and movement times in addition to correct responses in each session. Dopaminergic denervation of either the dorsal or ventral striatum ipsilaterally to the side in which the second lever to be pressed was located did not significantly change reaction and movement times, although it reduced the percentage of correct trials. A significant increase of both reaction and movement times was recorded only after bilateral denervation of the ventral striatum. The analysis of incorrect responses indicated that dopaminergic innervation of the two striatal subregions had different functions in the correct execution of the behavioral paradigm. In the group of animals with dorsal lesions the most frequent incorrect response was represented by a lack of the conditioned response to the presentation of the instruction stimulus starting the trial. If the animals reacted properly to this signal, the performance thereafter was correct in the majority of trials. Conversely, animals with ventral lesions exhibited a large repertoire of incorrect responses throughout the paradigm, including premature release or delayed press of levers, and omission of the second lever press. Histological verification of brain coronal sections by tyrosine-hydroxylase immunoreactivity showed that the lesions were confined in either the dorsal or ventral striatum, sparing the lateral region. The data support the hypothesis that dopaminergic innervation enables the two striatal regions to differently participate in the preparation and execution of complex delayed sensorimotor tasks. Indeed, the dorsal striatum seems to be involved in the correct utilization of external sensory information for the initiation of conditioned behavior, whereas, the ventral striatum appears to be mainly concerned with the temporal expectation of impending stimuli that trigger reward-reinforced movements.

Acoustic Stimulation↗
PubMed1999

[Carcinoid tumor of the appendix. A not especially rare entity].

Carcinoid tumors arise from neuroendocrine system and one of their preferred sites is the appendix. Most of appendiceal carcinoids almost always are clinically silent and are incidentally found at histological examination. For this reason, histological examination of the appendix is recommended in every case of the appendicectomy. Prognostic factors are: tumor stage, histologic pattern and differentiation. The authors present 6 cases of appendiceal carcinoid tumor, clinically silent and found at histologic examination (3 cases of appendicectomy for acute appendicitis, 3 cases of appendicectomy associated with abdominal surgical interventions for other pathology) and compare their experience with the most recent literature on this subject. The conclusion is drawn that the size of this tumor is the main factor that surgeons must consider for the choice of surgical treatment. Incidental, clinical silent, small (less than 2 cm in size) appendiceal carcinoid tumors can be treated by appendicectomy, and they do not need follow-up. Greater (more than 2 cm in size) appendiceal carcinoid tumors, in young patients must be treated with a right hemicolectomy and they need follow-up (periodically radiological, ultrasonographic and endoscopic examinations, tumor markers) because there is the possibility of recurrence or metastases.

Adult↗
PubMed1999

[Remodelling of the radial artery graft 5 years after aortocoronary bypass intervention].

BACKGROUND: The radial artery (RA) is being employed as coronary artery bypass graft with good results, but when it is proximally anastomosed to the ascending aorta, undergoes substantial hemodynamic changes which could lead to significant graft intimal hyperplasia. The aim of this study was to investigate the evolution of RA graft morphology over time. METHODS: We studied 20 patients with a perfectly patent RA graft at both 1 and 5 year angiography after coronary artery bypass graft. RESULTS: Both RA graft and grafted coronary artery diameters, assessed by quantitative coronary angiography, significantly increased at 5 years, in comparison to 1 year angiography (2.08 +/- 0.45 vs 2.54 +/- 0.53 mm, +22%, p < 0.001 and 1.92 +/- 0.47 vs 2.18 +/- 0.41 mm, +13.3%, p < 0.001, respectively). CONCLUSIONS: Hemodynamic changes following RA employment for coronary artery bypass graft stimulate a remodeling of RA graft itself and of the grafted coronary arteries. The progressive increase of diameters observed in RA grafts strongly argues against the development of flow-limiting graft intimal hyperplasia when RA is proximally anastomosed to the ascending aorta. Moreover, grafted coronary artery dilation suggests that hemorrheologic changes following coronary artery bypass graft could play a major role in the development of RA remodeling over time.

Analysis of Variance↗
PubMed1999

Thyroid nodules and Doppler ultrasonography. A new element for an old puzzle?

BACKGROUND: Whether Doppler ultrasonography (DU) may be of help in characterizing thyroid nodes is still under debate: both good and unsatisfactory results have been claimed, either in evaluating the presence of malignancy or in identifying hyperfunctional structures. METHODS: In this paper, the scintigraphic and Doppler patterns of 80 thyroid nodes have been compared, in the hypothesis that there may be some correlation between functional status and vascularity of the node; a small group of cyto-histological information were considered too. RESULTS: Perilesional flux seems to be, in general, somewhat more frequent than intranodal or mixed patterns: this is, however, true for all the groups of nodular functional conditions studied (peripheric flux was found in 70.2% of hyperfunctioning, 63.6% of isofunctioning and 59.3% of hypofunctioning nodes; intranodular flow was present in 18.9, 9 and 21.8% of hyper-, iso and hypofunctioning nodes respectively; mixed flow was found in 10.8% hyper, 27.2% iso and 18.7% hypofunctioning nodes). CONCLUSIONS: A prevalence of peripheric flow pattern is almost evenly distributed in all class of differently functioning nodes. Our data support the conclusion that no reliable correlations exist between scintigraphic and DU patterns: DU may not, therefore, be considered a valid substitute for nuclear imaging.

Adult↗
PubMed1998

Prognostic role of heart rate variability in patients with a recent acute myocardial infarction.

A low heart rate variability (HRV) has been shown to be a powerful predictor of cardiac events in patients surviving an acute myocardial infarction (MI), but it is not clear yet which among the HRV parameters has the best predictive value. Time domain and frequency domain HRV was assessed on 24-hour predischarge Holter recording of 239 patients with a recent MI. Patients were followed up for 6 to 54 months (median 28), during which 26 deaths (11%) occurred, 19 of which were cardiac in origin and 12 were sudden. Most HRVs did not show any difference between patients with or without mortality end points, but the average low-frequency and low-frequency/high-frequency ratio was lower in patients with events. However, when dichotomized according to cut points that maximized the risk of sudden death, several HRVs were significantly predictive of clinical end points. Overall, the mean of the standard deviations of all RR intervals for all 5-minute segments and the standard deviation of the mean RR intervals for all 5-minute segments were the time domain variables most significantly associated with mortality end points, whereas very low frequency was the most predictive frequency domain variable. Compared with the best time domain variables, very low frequency showed a better sensitivity (0.27 to 0.42 vs 0.19 to 0.33) for end points with only a small loss in specificity (0.92 vs 0.96). On multivariate Cox proportional analysis, a left ventricular ejection fraction <40% and a number of ventricular premature beats > or = 10/hour were the most powerful independent predictors for all end points, whereas no HRV was independently associated with the events. A low frequency/high frequency ratio < 1.05 only had a borderline association with sudden death (RR = 2.86, p = 0.076). Our data show a strong association between HRV and mortality in patients surviving a recent MI, with a slight better sensitivity of frequency domain analysis. In our study, however, HRV did not add independent prognostic information to more classic prognostic variables (e.g., left ventricular function and ventricular arrhythmias).

Aged↗
PubMed1998

The "warm-up" phenomenon occurs in patients with chronic stable angina but not in patients with syndrome X.

Most patients with chronic stable angina show an improvement in ischemic threshold when a second exercise test is performed a few minutes after a first positive test. In this study we evaluated whether this "warm-up" phenomenon also occurs in patients with syndrome X. We performed 2 consecutive exercise tests in 14 patients with chronic stable angina and 11 patients with syndrome X. The second exercise test was performed after 10 minutes from the end of the first one, always after complete recovery to baseline of ST segment. In patients with stable angina, heart rate (108+/-18 vs 99+/-16 beats/min, p = 0.005), rate-pressure product (17,020+/-4,541 vs 15,215+/-3,734 beats/min x mm Hg, p = 0.028), and exercise time (587+/-297 vs 444+/-244 seconds, p = 0.002) at 1-mm ST depression were higher in the second test than in the first one and a significant improvement in these parameters during the second test was also observed at peak exercise. Conversely, in patients with syndrome X, there were no significant differences between the 2 tests in heart rate (128+/-18 vs 131+/-23 beats/min), rate-pressure product (19,922+/-5,153 vs 19,390+/-5,654 beats/min x mm Hg), and exercise time (592+/-243 vs 566+/-228 seconds) at 1-mm ST-segment depression. Similarly, in this group of patients, no significant differences in exercise variables between the 2 tests were observed at peak exercise. Thus, unlike patients with chronic stable angina, patients with syndrome X have no evidence of warm-up in response to repeated exercise testing.

Adaptation, Physiological↗
PubMed1998

Enhancement of convective transport by internal filtration in a modified experimental hemodialyzer: technical note.

BACKGROUND: Hemodialysis using high flux membranes today is a commonly used therapy. The primary advantage is the larger spectrum of molecules removed with these membranes, and the mechanism of removal is in part due to a phenomenon of filtration and backfiltration along the length of the hollow fibers. We hypothesized that increasing the filtration and backfiltration fluxes by modifying the structure of the dialyzer could enhance the convective transport of various solutes. METHODS: A modified high flux dialyzer was compared to the standard model in terms of pressure profiles, filtration-backfiltration rates and solute clearances. The modification consisted on the placement of a O-ring around the fiber bundle to create a resistance for the flow of the dialysis solution external to the fibers. The study on filtration fluxes was carried out using a scintigraphic method previously described, and solute clearances were studied during ultrafiltration-controlled hemodialysis sessions. RESULTS: Utilizing a net filtration condition proximal to zero, the rates of proximal filtration and distal backfiltration in the experimental dialyzer were significantly enhanced in comparison with the standard dialyzer. The pressure drop in the dialysate compartment could be increased significantly, thus permitting an increase in the positive transmembrane pressure in the first half of the dialyzer and a parallel increase in the negative transmembrane pressure in the second half of the dialyzer. This resulted in a significant enhancement of the convective transport of middle-large solutes as demonstrated by the increase in vitamin B12 and inulin clearances. CONCLUSIONS: This approach suggests that changes in design of the dialyzer may affect its performance. The use of internal filtration is suggested to improve convection and dialyzer efficiency for larger solutes without the requirement for high volumes of replacement fluid, as is the case for current hemodiafiltration techniques.

Hemodiafiltration↗
PubMed1998

Appearance of Graves'-like disease following regression of autonomously functioning thyroid nodules. Two case reports.

Two cases are reported in which a rare hyperthyroidism appeared: in a female after radioiodine therapy for toxic multinodular goiter and in a male after spontaneous regression of a toxic adenoma. Both subjects showed a relapse of hyperthyroidism after a period of well-being lasting almost eight months in the first and three years in the second. Thyroid scans were consistent with an immunogenic hyper-thyroidism because there was a diffuse trapping of 131I in the thyroids while the previous autonomously functioning nodules became "cold". Serum TSH was undetectable, free thyroid hormones were increased, TgAb and TRAb were always normal in both patients, TPO became moderately positive only in the female. TRAb were evaluated only by radioimmunoassay. In these patients a diagnosis of Graves'-like disease was made because of the clinical and scintigraphic pattern. Moreover US did not reveal nodular areas different from those highlighted by scans. None of the subjects developed ophthalmopathy and/or dermopathy. Our remarks show that in particular subjects, genetically susceptible to autoimmunity, the release of antigenic materials secondary to destruction of thyroid nodules can trigger an autoimmune thyroid response resembling Graves' disease. Therefore all patients carrying autonomous nodules should be carefully evaluated for a possible autoimmune disposition before treatment and after admission. Radionuclide imaging is a simple, reliable, non invasive technique which can be applied in the evaluation of the etiology of the relapses.

Adenoma↗
PubMed1997

Mechanisms of adenosine-induced epicardial coronary artery dilatation.

BACKGROUND: In order to ascertain whether human adenosine-induced dilatation of epicardial arteries is direct or flow-mediated, we compared the effects of intracoronary adenosine infusion on epicardial coronary arteries with those produced by dipiridamole, a selective arteriolar vasodilator. METHODS AND RESULTS: In 24 patients with angiographically normal coronary arteries, coronary blood flow velocity was measured by a Doppler wire during intracoronary infusion of adenosine or dipyridamole, which is known to increase intramyocardial adenosine concentration. Coronary angiograms were obtained at baseline and immediately after the end of each infusion period; coronary diameters 5 mm distal to the wire tip were measured by computer-assisted quantitative coronary angiography. Peak coronary blood flow velocities during adenosine or dipyridamole infusions were similar (52.0 +/- 15.5 and 47.9 +/- 24.2 cm.s-1, P = ns). Coronary diameters immediately after adenosine and dipyridamole infusions were similar and both higher than that at baseline (2.80 +/- 0.63 and 2.86 +/- 0.64 vs 2.44 +/- 0.69 mm, P < 0.05). The absolute and percentage increases of coronary artery diameters in response to adenosine were highly correlated to coronary blood flow velocity (R = 0.622, intercept -0.10 +/- 0.14, P = 0.002 and R = 0.617, intercept -15.2 +/- 9.9, P = 0.001, respectively); similar correlations were found in response to dipyridamole (R = 0.708, intercept -0.44 +/- 0.19, P < 0.001 and R = 0.649, intercept -13.5 +/- 8.7, P < 0.001, respectively). Finally the absolute and percentage changes of coronary artery diameters caused by adenosine were highly correlated to those caused by dipyridamole (R = 0.840 P < 0.001 and R = 0.836, P < 0.001 respectively). CONCLUSIONS: A significant correlation exists between epicardial coronary vasodilation and coronary blood flow velocity during intracoronary adenosine infusion, thus suggesting that epicardial coronary vasodilation induced by adenosine is predominantly flow-mediated rather than direct. This conclusion is supported by the observation that similar findings were obtained using dipyridamole, which can only dilate epicardial coronary arteries indirectly, through the increase in coronary blood flow velocity caused by the inhibition of intramyocardial adenosine re-uptake.

Adenosine↗