Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling

Gian Gastone Neri Serneri, Maria Boddi, Luciano Arata, Carlo Rostagno, Piero Dabizzi, Mirella Coppo, Mauro Bini, Stefano Lazzerini, Armando Dagianti, Gian Franco Gensini

Research output: Contribution to journalArticle

Abstract

Background. Inferential evidence suggests that silent ischemia might be related to sympathetic activity. Study of [3H]norepinephrine kinetics is a suitable tool to assess the regional sympathetic activity. This method was applied to investigate whether silent myocardial ischemia in unstable angina is related to and depends on cardiac sympathetic overactivity. Methods and Results. Patients with active unstable angina were compared with patients with inactive unstable angina, stable effort angina, and controls. Silent myocardial ischemia was evaluated by three 24-hour Holter monitoring periods on alternate days, and [3H] norepinephrine kinetics was assessed under rest conditions and following the cold pressor test. Simultaneously, catecholamine concentrations were measured in the aortic, coronary sinus, and peripheral venous blood. Different than the other groups (p=0.0013), in patients with active unstable angina, the majority of silent ischemic episodes occurred without increase in heart rate. These patients had a positive coronary sinus-aorta norepinephrine gradient, both at rest and following the cold pressor test. [3H] Norepinephrine kinetics demonstrated an increased selective cardiac spillover, both at rest and, even more, after the cold pressor test. Reduced cardiac [3H] norepinephrine extraction also was found. A significant relation was found between the number of ischemic episodes or the overall duration of silent ischemia and norepinephrine spillover, both at rest and following cold application. Conclusions. During the acute phase of unstable angina (but not in the quiescent phase or in stable effort angina), a disorder in cardiac norepinephrine handling occurs. This results in a reflex cardiac sympathetic overactivity that plays a major role in the occurrence of silent myocardial ischemia.

Original languageEnglish
Pages (from-to)1928-1937
Number of pages10
JournalCirculation
Volume87
Issue number6
Publication statusPublished - Jun 1993

Fingerprint

Unstable Angina
Norepinephrine
Ischemia
Myocardial Ischemia
Stable Angina
Coronary Sinus
Sinus of Valsalva
Ambulatory Electrocardiography
Catecholamines
Reflex
Aorta
Heart Rate

Keywords

  • Angina
  • Ischemia
  • Norepinephrine

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Serneri, G. G. N., Boddi, M., Arata, L., Rostagno, C., Dabizzi, P., Coppo, M., ... Gensini, G. F. (1993). Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling. Circulation, 87(6), 1928-1937.

Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling. / Serneri, Gian Gastone Neri; Boddi, Maria; Arata, Luciano; Rostagno, Carlo; Dabizzi, Piero; Coppo, Mirella; Bini, Mauro; Lazzerini, Stefano; Dagianti, Armando; Gensini, Gian Franco.

In: Circulation, Vol. 87, No. 6, 06.1993, p. 1928-1937.

Research output: Contribution to journalArticle

Serneri, GGN, Boddi, M, Arata, L, Rostagno, C, Dabizzi, P, Coppo, M, Bini, M, Lazzerini, S, Dagianti, A & Gensini, GF 1993, 'Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling', Circulation, vol. 87, no. 6, pp. 1928-1937.
Serneri GGN, Boddi M, Arata L, Rostagno C, Dabizzi P, Coppo M et al. Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling. Circulation. 1993 Jun;87(6):1928-1937.
Serneri, Gian Gastone Neri ; Boddi, Maria ; Arata, Luciano ; Rostagno, Carlo ; Dabizzi, Piero ; Coppo, Mirella ; Bini, Mauro ; Lazzerini, Stefano ; Dagianti, Armando ; Gensini, Gian Franco. / Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling. In: Circulation. 1993 ; Vol. 87, No. 6. pp. 1928-1937.
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AU - Serneri, Gian Gastone Neri

AU - Boddi, Maria

AU - Arata, Luciano

AU - Rostagno, Carlo

AU - Dabizzi, Piero

AU - Coppo, Mirella

AU - Bini, Mauro

AU - Lazzerini, Stefano

AU - Dagianti, Armando

AU - Gensini, Gian Franco

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N2 - Background. Inferential evidence suggests that silent ischemia might be related to sympathetic activity. Study of [3H]norepinephrine kinetics is a suitable tool to assess the regional sympathetic activity. This method was applied to investigate whether silent myocardial ischemia in unstable angina is related to and depends on cardiac sympathetic overactivity. Methods and Results. Patients with active unstable angina were compared with patients with inactive unstable angina, stable effort angina, and controls. Silent myocardial ischemia was evaluated by three 24-hour Holter monitoring periods on alternate days, and [3H] norepinephrine kinetics was assessed under rest conditions and following the cold pressor test. Simultaneously, catecholamine concentrations were measured in the aortic, coronary sinus, and peripheral venous blood. Different than the other groups (p=0.0013), in patients with active unstable angina, the majority of silent ischemic episodes occurred without increase in heart rate. These patients had a positive coronary sinus-aorta norepinephrine gradient, both at rest and following the cold pressor test. [3H] Norepinephrine kinetics demonstrated an increased selective cardiac spillover, both at rest and, even more, after the cold pressor test. Reduced cardiac [3H] norepinephrine extraction also was found. A significant relation was found between the number of ischemic episodes or the overall duration of silent ischemia and norepinephrine spillover, both at rest and following cold application. Conclusions. During the acute phase of unstable angina (but not in the quiescent phase or in stable effort angina), a disorder in cardiac norepinephrine handling occurs. This results in a reflex cardiac sympathetic overactivity that plays a major role in the occurrence of silent myocardial ischemia.

AB - Background. Inferential evidence suggests that silent ischemia might be related to sympathetic activity. Study of [3H]norepinephrine kinetics is a suitable tool to assess the regional sympathetic activity. This method was applied to investigate whether silent myocardial ischemia in unstable angina is related to and depends on cardiac sympathetic overactivity. Methods and Results. Patients with active unstable angina were compared with patients with inactive unstable angina, stable effort angina, and controls. Silent myocardial ischemia was evaluated by three 24-hour Holter monitoring periods on alternate days, and [3H] norepinephrine kinetics was assessed under rest conditions and following the cold pressor test. Simultaneously, catecholamine concentrations were measured in the aortic, coronary sinus, and peripheral venous blood. Different than the other groups (p=0.0013), in patients with active unstable angina, the majority of silent ischemic episodes occurred without increase in heart rate. These patients had a positive coronary sinus-aorta norepinephrine gradient, both at rest and following the cold pressor test. [3H] Norepinephrine kinetics demonstrated an increased selective cardiac spillover, both at rest and, even more, after the cold pressor test. Reduced cardiac [3H] norepinephrine extraction also was found. A significant relation was found between the number of ischemic episodes or the overall duration of silent ischemia and norepinephrine spillover, both at rest and following cold application. Conclusions. During the acute phase of unstable angina (but not in the quiescent phase or in stable effort angina), a disorder in cardiac norepinephrine handling occurs. This results in a reflex cardiac sympathetic overactivity that plays a major role in the occurrence of silent myocardial ischemia.

KW - Angina

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