Endothelial injury may contribute to the augmented coronary vascular tone seen in myocardial ischemia by impairing endothelial production or release of vasodilators. In vitro reactivity of arterial rings was studied after 60 min of coronary occlusion and 60 min of reperfusion in anesthetized dogs. Ischemia without reperfusion blunted contractile reactivity to potassium chloride (KCI), whereas ischemia plus reperfusion augmented contractile responses to both KCI and ergonovine. The response to acetylcholine, an endothelium-dependent vasodilator, was abolished in reperfused arteries, whereas the response to nitroprusside, an endothelium-independent vasodilator, was intact. Verapamil pretreatment restored KCI contractile responses to normal in reperfused coronary rings and partially restored endotheliumdependent relaxation. Electron microscopy revealed a nondenuding epicardial coronary endothelial injury in reperfused arteries. These data support the hypothesis that reperfusion of ischemic myocardium augments reactivity to vasoconstrictor agents by causing endothelial cell damage, excessive calcium influx, and loss of modulating vasodilator function.
IntroductionCoronary artery "spasm" has been identified as the basis of "variant" or "Prinzmetal" angina (1, 2), as a precipitant ofmyocardial infarction (3), and as a frequent factor in unstable and postinfarction angina (4-6). The mechanism by which this abnormal form of coronary vasoconstriction occurs is not known. However, recent interest has focused on the vascular endothelium as a determinant of vasodilator tone. Furchgott described a chemical "relaxing" factor, which is produced by endothelial cells and vasodilates coronary and other systemic arteries (7). Damage to the endothelium may impair release of this relaxing factor or other endothelial-derived vasodilators, and cause vasoconstriction. Recent studies have assessed the role of the endothelium in modulating coronary vascular tone by mechanically removing the endothelium oflarge, epicardial coronary artenes. Deendothelialization produces spontaneous local vasoconstric-