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Endothelium-dependent relaxations mediated by Gi protein are prominently impaired in atherosclerotic coronary arteries. However, it remains to be determined whether the expression of endothelial Gi protein per se is reduced in coronary atherosclerosis. Thus, in the present study the expression of endothelial Gi protein was examined by immunohistochemical staining using a specific antibody against human Gi protein (alpha-subunits of Gi-1 and Gi-2 proteins) in the proximal segment of the left anterior descending coronary arteries (segment 6) from 40 consecutive autopsy cases. The immunoreactive level of the Gi protein was semi-quantitated in four grades (none, 0; slight, +; moderate, +2; high, +3) and the mean value of the ratings of all endothelial cells was used as an index of the endothelial Gi protein expression of the artery. The immunoreactive level of the Gi protein in human coronary arteries was significantly reduced with ageing and extent of coronary atherosclerosis (both P < 0.05), and was lower in patients with than in those without hypertension (P < 0.01) or hyperlipidaemia (P < 0.05). In addition, the level was significantly lower in the eccentric portions than in the concentric ones in each atherosclerotic coronary artery (P < 0.0001). These alterations in the immunoreactive level of endothelial Gi protein in human coronary arteries may explain, in part, why Gi protein-mediated, endothelium-dependent relaxations are prominently impaired in atherosclerosis.

Objective: To investigate serial assessments of systolic coronary flow reversal in the infarct related artery for predicting poor left ventricular functional recovery after reperfused acute myocardial infarction. Setting: Regional hospital. Patients and methods: 49 patients with anterior acute myocardial infarction had transthoracic Doppler echocardiography to record coronary flow velocity in the left anterior descending coronary artery immediately after successful primary coronary angioplasty (day 0), and at 48 hours, one week, and three weeks. Main outcome measures: Coronary flow velocity at each time point; regional wall motion score index (RWMSI) at day 0 and at three weeks. Irreversible dysfunction was defined as a decrease in RWMSI to < 0.22. Results: Measurements of coronary flow velocity could be made in 45 patients. Patients were divided into three groups: no systolic flow reversal (group 1, n = 27), systolic flow reversal observed only on day 0 (group 2, n = 8), and systolic flow reversal persisting until 48 hours (group 3, n = 10). Although baseline RWMSI was similar among the three groups, the value at three weeks was significantly higher in group 3 than in the other two groups. In predicting irreversible dysfunction, the persistence of systolic flow reversal up to 48 hours had a higher positive predictive value (100%) than the presence of systolic flow reversal on day 0 (67%, p < 0.04). The negative predictive value of systolic flow reversal at 48 hours (83%) was comparable in accuracy to the presence of systolic flow reversal on day 0 (85%, NS). Conclusions: In reperfused anterior acute myocardial infarction, serial assessment of coronary flow velocity in the left anterior descending coronary artery is feasible using transthoracic Doppler echocardiography, and the persistence of systolic flow reversal at 48 hours is a more specific marker of irreversible dysfunction than peak creatine kinase or diastolic deceleration time. P rimary coronary angioplasty is an effective method for improving prognosis in patients with acute myocardial infarction.1 However, successful angioplasty does not always guarantee adequate tissue perfusion of the myocardium distal to the previously occluded vessel.2 3 Some patients develop the no reflow phenomenon, which is associated with sustained left ventricular dysfunction, left ventricular remodelling, and subsequent poor outcome.4 5 The characteristic coronary flow velocity profile of systolic flow reversal is observed immediately after reperfusion has been achieved in patients with the no reflow phenomenon 6 and is associated with poor functional recovery.7 Although early prediction of the recovery of left ventricular dysfunction is important for identifying high risk patients and selecting the appropriate therapeutic strategy, many confounding factors-including coronary hyperaemia, reperfusion injury, and microvascular stunningaffect coronary flow to the previously ischaemic myocardium over time. 8Transthoracic Doppler echocardiography may be suitable for the serial as...

The possible preventive effect of cilostazol, a novel anti-platelet drug, on restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) was examined. One hundred and two consecutive patients, who underwent successful PTCA, were followed for 3 to 6 months. To prevent restenosis, 46 patients (60 PTCA sites) were treated with cilostazol alone (200 mg/day) (cilostazol group) and the remaining 56 (61 PTCA sites) were treated with other anti-platelet drugs and/or warfarin potassium (control group). Restenosis was defined as a more than 50% loss of the initial gain of the coronary diameter achieved by PTCA. Cilostazol did not significantly reduce the patient or lesion restenosis rate; the patient restenosis rate was 32% in the control group and 22% in the cilostazol group (P = 0.24), and the lesion restenosis rate was 30% in the control group and 23% in the cilostazol group (P = 0.44). However, the lesion non-progression rate, which was defined as the incidence of lesions with either no change or regression of coronary stenosis at the PTCA site, was significantly greater with cilostazol (37%) than in the control group (16%) (p < 0.05). Although cilostazol failed to show a significant reduction in restenosis after PTCA, the present results suggest that a further trial with a larger number of patients is needed to confirm its usefulness.