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Myocardial Perfusion in Hypertensive Patients with Normal Coronary Arteries

  • Carlo PalomboEmail author
  • Michaela Kozàkovà
  • Giovanni Bigalli
  • Danilo Neglia
  • Alessandro Distante
  • Oberdan Parodi
  • Antonio L’Abbate
Chapter
  • 88 Downloads
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 432)

Abstract

Arterial hypertension represents a major risk factor for cardiovascular morbidity and mortality: increasing experimental and clinical evidence suggest that a major role can be played by myocardial ischemia. A reduction of coronary vasodilator reserve, i.e. the capability of coronary system to increase flow in response to an increased metabolic demand, has been reported in several models of animal and human hypertension even in absence of angiographically detectable coronary atherosclerosis (1–4).

Keywords

Myocardial Perfusion Hypertensive Patient Myocardial Blood Flow Coronary Flow Coronary Flow Reserve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Opherk D, Mall G, Zebe H, Schwarz F, Weihe E, Manthey J, Kubler W. Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation 1984; 69:1–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Brush JE, Cannon RO, Schenke WH. Angina due to coronary microvascular disease in hypertensive patients without left ventricular hypertrophy. N Engl J Med 1988; 319:1302–1307.PubMedCrossRefGoogle Scholar
  3. 3.
    Strauer BE. The significance of coronary reserve in clinical heart disease. JACC 1990; 15:775–783.PubMedGoogle Scholar
  4. 4.
    Marcus ML, Harrison DG. Alterations in the coronary circulation in hypertrophied ventricles. Circulation 1987; 75(Suppl I):I19–I25.PubMedGoogle Scholar
  5. 5.
    Harrison DG, Florentine MS, Brooks LA, Cooper SM, Marcus ML. The effect of hypertension and left ventricular hypertrophy on the lower range of coronary autoregulation. Circulation 1988; 77:1108–1115.PubMedCrossRefGoogle Scholar
  6. 6.
    Polese A, De Cesare N, Montorsi P, Fabbiocchi F, Guazzi M, Loaldi A, Guazzi MD. Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle. Circulation 1991; 83:845–853.PubMedCrossRefGoogle Scholar
  7. 7.
    Schwartzkopff B, Motz W, Frenzel H, Vogt M, Knauer S, Strauer BE. Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension. Circulation 1993; 88:993–1003.PubMedCrossRefGoogle Scholar
  8. 8.
    Treasure CB, Klein JL, Vita JA, Manoukian SV, Renwick GH, Selwyn AP, Ganz P, Alexander RW. Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels. Circulation 1993; 87:86–93.PubMedCrossRefGoogle Scholar
  9. 9.
    Cannon RO III, Epstein SE. “Microvascular angina” as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol 1988; 61:1338–1343.PubMedCrossRefGoogle Scholar
  10. 10.
    Tomanek RJ, Palmer PJ, Pfeiffer GL, Schreiber KL, Eastham CL, Marcus ML. Morphometry of canine coronary arteries, arterioles, and capillaries during hypertension and left ventricular hypertrophy. Circ Res 1986; 58:38–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Duncker DJ, Zhang J, Bache RJ. Coronary pressure-flow relation in left ventricular hypertrophy. Importance in changes in back pressure versus changes in minimum resistance. Circ Res 1993; 72:579–587.PubMedCrossRefGoogle Scholar
  12. 12.
    L’Abbate A. Methodology of coronary blood flow measurements in humans: present status and future advancement. Cardiovasc. Pharmacol. 1987; 10(Suppl. 5):S120–S122.Google Scholar
  13. 13.
    Wolters-Geldof, Manger Cats V, Bruschke AVG. Clinical methods to determine coronary flow and myocardial perfusion. Int J Card Imag 1997; 13:79–94.CrossRefGoogle Scholar
  14. 14.
    Iliceto S, Marangelli V, Memmola C, Rizzon P. Transesophageal Doppler echocardiography evaluation of coronary blood flow velocity in baseline conditions and during dipyridamole-induced coronary vasodilation. Circulation 1991; 83:61–69.PubMedCrossRefGoogle Scholar
  15. 15.
    Kozàkovà M, Palombo C, Pratali L., Bigalli G., Marzilli M., Distante A., L’Abbate A. Assessment of coronary reserve by transesophageal Doppler echocardiography. Direct comparison beetiween different modalities of dypiridamole and adenosine administation. Eur Heart J 1997; 18:514–523.PubMedCrossRefGoogle Scholar
  16. 16.
    Redberg RF, Sobol Y, Chou TM, Malloy M, Kumar S, Botvinick E, Kane J. Adenosine-induced coronary vasodilation during transesophageal Doppler echocardiography. Rapid and safe measurement of coronary flow reserve ratio can predict significant left anterior descending coronary stenosis. Circulation. 1995; 92:190–196.PubMedCrossRefGoogle Scholar
  17. 17.
    Palombo C, Kozàkovà M, Pratali L, Bigalli G, Gaietta F, L’Abbate A. Transesophageal Echo-Doppler for Study of Coronary Flow Reserve: Feasibility and Normalcy Criteria. J Am Coll Cardiol 1997; 2(supplement A):364A.Google Scholar
  18. 18.
    Wilson RF, Laughlin DE, Ackel PH, Chilian WM, Holida CJ. Transluminal, subselective measurement of coronary artery blood flow velocity and vasodilator reserve in man. Circulation 1985; 72:82–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Camici PG, Gropler RJ, Jones T, L’Abbate A, Maseri A, Melin JA, Merlet P, Parodi O, Schelbert HR, Schwaiger M, Wijns W. The impact of myocardial blood flow quantitation with PET on the understanding of cardiac diseases. Eur Heart J 1996; 17:25–34.PubMedCrossRefGoogle Scholar
  20. 20.
    Doucette JW, Corl PD, Payne HM, Flynn AE, Goto M, Nassi M. Validation of a Doppler guide wire for intravascular measurements of coronary artery flow velocity. Circulation 1992; 85:1899–1911.PubMedCrossRefGoogle Scholar
  21. 21.
    Radvan J, Marwick T, Williams J, Camici P. Evaluation of the extent and timing of the coronary hyperemic response to dipyridamole. A study with transesophageal echocardiography and positron emission tomography with oxygen 15 water. J Am Soc Echocardiography. 1995; 8:864–873.CrossRefGoogle Scholar
  22. 22.
    Kozàkovà M, Palombo C, Pratali L, Pittella G, Gaietta F, L’Abbate A. Mechanisms of coronary flow reserve impairment in human hypertension. An integrated approach by transthoracic and transesophageal echocardiography. Hypertension 1997; 29:551–559.PubMedCrossRefGoogle Scholar
  23. 23.
    Kozàkovà M, Palombo C, Gaietta F, Pratali L, Giusti C, L’Abbate A. Structural and functional adaptation of coronary circulation in endurance athletes: a study by transesophageal echo-doppler. Eur. Heart J 1996; 17 (abstracts suppl.):89.Google Scholar
  24. 24.
    Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977; 55:613–618.PubMedCrossRefGoogle Scholar
  25. 25.
    de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH. Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol. 1995; 25:1056–1062.PubMedCrossRefGoogle Scholar
  26. 26.
    Savage DD, Garrison RJ, Kannel WB, Levy D, Anderson SJ, Stokes J III, Feinleib M, Castelli WP. The spectrum of left ventricular hypertrophy in general population sample: The Framingham study. Circulation. 1987; 75(Suppl. I):I-26–I-33.Google Scholar
  27. 27.
    Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992; 19:1550–1558.PubMedCrossRefGoogle Scholar
  28. 28.
    de Simone G, Devereux RB, Roman MJ, Ganau A, Saba PS, Alderman MH, Laragh JH. Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol. 1994; 23:1444–1451.PubMedCrossRefGoogle Scholar
  29. 29.
    Wilson JR, Reichek N, Hirshfeld J, Keller CA. Noninvasive assessment of load reduction in patients with asymptomatic aortic regurgitation. Am J Med. 1980; 68:664–674.PubMedCrossRefGoogle Scholar
  30. 30.
    Reichek N, Wilson J, St.John Sutton M, Plappert TA, Goldberg S, Hirshfeld JW. Noninvasive determination of left ventricular end-systolic stress: Validation of the method and initial application. Circulation. 1982; 65:99–108.PubMedCrossRefGoogle Scholar
  31. 31.
    Kozàkovà M, Palombo C, Gaietta F., Bigalli G., Giusti C., L’Abbate A. Enhanced Flow-Mediated Coronary Dilation in Endurance Athelets: a Study by Means of Transesophageal Echo-Doppler. Circulation 1996; 94 (abstracts suppl.):I–305.Google Scholar
  32. 32.
    Parodi O, Neglia D, Palombo C, Sambuceti G, Giorgetti A, Marabotti C, Gallopin M, Simonetti I, and L’Abbate A. Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension. Circulation 1997; in press. Google Scholar
  33. 33.
    Bellina CR, Parodi O, Camici P, Salvadori PA, Taddei L, Fusani L, Guzzardi R, Klassen GA, L’Abbate A, Donato L. Simultaneous in vitro and in vivo validation of nitrogen-13-ammonia for the assessment of regional myocardial blood flow. J Nucl Med. 1990; 31:1335–43.PubMedGoogle Scholar
  34. 34.
    Gimelli A., Neglia D., Sambuceti G., Giorgetti A., Palombo C., Pedrinelli R., Parodi O. No Relationship Between Maximum Coronary Flow and Resistance and Left Ventricular Mass in Essential Hypertension. J Am Coll Cardiol 1996; 2(supplement A):106A.Google Scholar
  35. 35.
    Palombo C., Neglia D., Sambuceti G., Marabotti C., L’Abbate A., Parodi O. Transient ECG Abnormalities During Increased Metabolic Demand and Dipyridamole Infusion Identify Different Patterns of Myocardial Perfusion in Hypertensive Patients. J Am Coll Cardiol 1993; 21:287A.CrossRefGoogle Scholar
  36. 36.
    Opherk D, Zebe H, Weihe E, Mall AG, Durr Ch, Gravert B, Mehmel HC, Schwarz F, Kubler W. Reduced coronary dilator capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary angiograms. Circulation. 1981; 63:1817–1822.CrossRefGoogle Scholar
  37. 37.
    Sheridan DJ, McAinsh A, O’Gorman DJ. The coronary circulation in cardiac hypertrophy. J Cardiovasc Pharmacol. 1993; 22:S18–S28.PubMedGoogle Scholar
  38. 38.
    Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastman CL. A mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med. 1982; 307:1362–1367.PubMedCrossRefGoogle Scholar
  39. 39.
    Cannon RO, Rosing DR, Maron BJ, Leon MB, Bonow RO, Watson RM, Epstein SE. Myocardial ischemia in patients with hypertrophic cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Circulation. 1985; 71:234–243.PubMedCrossRefGoogle Scholar
  40. 40.
    Vogt M, Motz W, Strauer BE. Coronary haemodynamics in hypertensive heart disease. Eur Heart J. 1992; 13(suppl D):44–49.PubMedCrossRefGoogle Scholar
  41. 41.
    Wangler RD, Peters KG, Marcus ML, Tomanek RJ. Effects of duration and severity of arterial hypertension and cardiac hypertrophy on coronary vasodilator reserve. Circ Res. 1982; 51:10–18.PubMedCrossRefGoogle Scholar
  42. 42.
    Tomanek RJ, Schalk KA, Marcus ML, Harrison DG. Coronary angiogenesis during long-term hypertension and left ventricular hypertrophy in dogs. Circ Res. 1989; 65:352–359.PubMedCrossRefGoogle Scholar
  43. 43.
    Tanaka M, Fujiwara H, Onodera T, Hamashima Y, Kawai C. Quantitative analysis of narrowings of intramyocardial small arteries in normal hearts, hypertensive hearts and hearts with hypertrophic cardiomyopathy. Circulation. 1987; 75:1130–1139.PubMedCrossRefGoogle Scholar
  44. 44.
    Schwartzkopff B, Motz W, Frenzel H, Vogt M, Knauer S, Strauer BE. Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension. Circulation. 1993; 88:993–1003.PubMedCrossRefGoogle Scholar
  45. 45.
    Antony I, Lerebours G, Nitenberg A. Loss of flow dependent coronary artery dilation in patients with hypertension. Circulation. 1995; 91:1624–1628.PubMedCrossRefGoogle Scholar
  46. 46.
    Kuo L, Davis MJ, Chilian WH. Endothelium-dependent, flow-induced dilation of isolated coronary arterioles. Am J Physiol. 1990; 259:H1063–H1070.PubMedGoogle Scholar
  47. 47.
    Hintze TH, Vatner SF. Dipyridamole dilates large coronary arteries in conscious dogs. Circulation. 1983; 68:1321–1327.PubMedCrossRefGoogle Scholar
  48. 48.
    Drexler H, Zeiher AM, Wollschlager H, Meinertz T, Just H, Bonzel T. Flow-dependent coronary artery dilation in humans. Circulation. 1989; 80:466–474.PubMedCrossRefGoogle Scholar
  49. 49.
    Brush JE, Faxon DP, Salmon S, Jacobs AK, Ryan TJ. Abnormal endothelium dependent coronary vasomotion in hypertensive patients. J Am Coll Cardiol. 1992; 19:809–815.PubMedCrossRefGoogle Scholar
  50. 50.
    Treasure CB, Klein JL, Vita JA, Manoukian SV, Renwick GH, Selwyn AP, Ganz P, Alexander RW. Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels. Circulation. 1993; 87:86–93.PubMedCrossRefGoogle Scholar
  51. 51.
    Chilian WM, Eastham CL, Layne SM, Marcus ML. Small vessel phenomena in the coronary microcirculation: phasic intramyocardial perfusion and microvascular dynamics. Prog Cardiovasc Dis 1988; 31:17–18.PubMedCrossRefGoogle Scholar
  52. 52.
    Marcus ML, Chilian WM, Kanatsuka H, Dellsperger KC, Eastham CL, Lamping KG. Understanding the coronary circulation through studies at the microvascular level. Circulation 1990; 82:1–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Chilian WM, Layne SM, Eastham CL, Marcus ML. Heterogeneous microvascular coronary a-adrenergic vasoconstriction. Circ Res 1989; 64:376–388.PubMedCrossRefGoogle Scholar
  54. 54.
    Camici P, Chiriatti G, Lorenzoni R, Bellina RC, Gistri R, Italiani G, Parodi O, Salvadori PA, Nista N, Papi L, L’Abbate A. Coronary vasodilation is impaired in both hypertrophied and non hypertrophied myocardium of patients with hypertrophic cardiomyopathy: a study with nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol. 1991; 17:879–886.PubMedCrossRefGoogle Scholar
  55. 55.
    Folkow B, Hallback M, Noresson E. Vascular resistance and reactivity of the microcirculation in hypertension. Blood Vessels. 1978; 15:33–45.PubMedGoogle Scholar
  56. 56.
    Tanaka M, Fujiwara H, Onodera T, Hamashima Y, Kawai C. Quantitative analysis of narrowings of intramyocardial small arteries in normal hearts, hypertensive hearts and hearts with hypertrophic cardiomyopathy. Circulation. 1987;75:1130–1139.PubMedCrossRefGoogle Scholar
  57. 57.
    Brilla CG, Janicki JS, Weber KT. Impaired diastolic function and coronary reserve in genetic hypertension. Role of interstitial fibrosis and medial thickening of intramyocardial coronary arteries. Circ Res. 1991; 69:2107–115.CrossRefGoogle Scholar
  58. 58.
    Jones CJH, Kuo L, Davis MJ, DeFily DV, Chilian WM. Role of nitric oxide in the coronary microvascular responses to adenosine and increased metabolic demand. Circulation. 1995; 91:1807–1813.PubMedCrossRefGoogle Scholar
  59. 59.
    Kuo L, Chilian WM, Davis MJ. Interaction of pressure and flow-induced responses in porcine coronary resistance vessels. Am J Physiol. 1991; 261:H1706–H1715.PubMedGoogle Scholar
  60. 60.
    Folkow B. The fourth Volhard lecture. Cardiovascular structural adaptation: its role in the initiation and maintainance of primary hypertension. Clin Sci Mol Med. 1975; 48:205–211.Google Scholar
  61. 61.
    Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Circulation; 83:1849–1865.Google Scholar
  62. 62.
    Gardin JM, Drayer JIM, Weber M. Doppler echocardiographic assessment of left ventricular systolic and diastolic function in mild hypertension. Hypertension. 1987; 9(suppl II):II-90–II-96.Google Scholar
  63. 63.
    Marabotti C, Genovesi Ebert A, Palombo C, Giaconi S, Michelassi C, Ghione S. Echo-Doppler assessment of left ventricular filling in borderline hypertension. Am J Hypertens. 1989; 2:891–897.PubMedGoogle Scholar
  64. 64.
    Vatner SF, Shannon R, Hittinger L. Reduced subendocardial coronary reserve. A potential mechanism for impaired diastolic function in the hypertrophied and failing heart. Circulation. 1990; 81(suppl III):III-8–III-14.Google Scholar
  65. 65.
    Bache RJ, Vrobel TR, Ring SW, Emery RW, Andersen RW. Regional myocardial blood flow during exercise in dogs with chronic left ventricular hypertrophy. Circ Res. 1981; 48:76–81.PubMedCrossRefGoogle Scholar
  66. 66.
    Hittingher L, Mirsky I, Shen YT, Patrick TA, Bishop SP, Vatner SF. Hemodynamic mechanisms responsible for reduced subendocardial coronary reserve in dogs with severe left ventricular hypertrophy. Circulation. 1995; 92:978–986.CrossRefGoogle Scholar
  67. 67.
    Houghton JL, Frank MJ, Carr AA, von Dohlen TW, Prisant ML. Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery. J Am Coll Cardiol. 1990; 15:43–51.PubMedCrossRefGoogle Scholar
  68. 68.
    Weber KT, Janicki JS. The metabolic demand and oxygen supply of the heart: Physiological and clinical considerations. Am J Cardiol. 1979; 44:722–729.PubMedCrossRefGoogle Scholar
  69. 69.
    Hittinger L, Patrick T, Ihara T, Hasebe N, Shen Y-T, Kalthof B, Shannon RP, Vatner SF. Exercise induces cardiac dysfunction in both moderate, compensated and severe hypertrophy. Circulation. 1994; 89:2219–2231.PubMedCrossRefGoogle Scholar
  70. 70.
    Gunther S, Grossman W. Determination of ventricular function in pressure-overload hypertrophy in man. Circulation. 1979; 59:679–688.PubMedCrossRefGoogle Scholar
  71. 71.
    Motz W, Strauer BE. Improvement of coronary flow reserve after long-term therapy with enalapril. Hypertension 1996; 27:1031–1038.PubMedCrossRefGoogle Scholar
  72. 72.
    Palombo C, Neglia D, Bigalli G, Sambuceti G, Marabotti C, Parodi O. Antihypertensive therapy improves regional myocardial blood flow and reduces perfusion dyshomogeneity in patients with hypertension and no coronary artery disease. Circulation 1993; 88:1167.Google Scholar
  73. 73.
    Brilla CG, Janicki JS, Weber KT. Cardioreparative effects of lisinopril in rats with genetic hypertension and left ventricular hypertrophy. Circulation. 1991; 5:1771–1779.CrossRefGoogle Scholar
  74. 74.
    Clozel JP, Kuhn H, Hefti F. Effects of chronic ACE-inhibition on cardiac hypertrophy and coronary vascular reserve in spontaneously hypertensive rats with developed hypertension. J Hypertens. 1989; 7:267–275.PubMedGoogle Scholar
  75. 75.
    Marban E, Koretsune Y. Cell calcium, oncogens and hypertrophy. Hypertension. 1990; 15:652–658.PubMedCrossRefGoogle Scholar
  76. 76.
    Motz W, Strauer BE. Left ventricular function and collagen content after regression of hypertensive hypertrophy. Hypertension. 1989; 13:43–50.PubMedCrossRefGoogle Scholar
  77. 77.
    Vogt M, Kreutz KU, Motz W, Strauer BE. Regression of hypertrophy with nitrendipine: effects on systolic and diastolic function. Z Kardiol. 1989; 78:469–477.PubMedGoogle Scholar
  78. 78.
    Frielingsdorf J, Seiler C, Kaufmann P, Vassalli G, Suter T, Hess OM. Normalization of abnormal coronary vasomotion by calcium antagonists in patients with hypertension. Circulation. 1996; 93:1380–1387.PubMedCrossRefGoogle Scholar
  79. 79.
    Haskell WL, Sims C, Myll Y, Bortz WM, Goar FGS, Alderman EL. Coronary artery size and dilating capacity in ultradistance runners. Circulation 1993; 87:1076–1082.PubMedCrossRefGoogle Scholar
  80. 80.
    Berdeux A, Ghalen B, Dubois-Randé JL, Vigué B, La Rochelle CD, Hittinger L, Giudicelli JF. Role of vascular endothelium in exercise-induced dilation of large epicardial coronary arteries in concious dogs. Circulation 1994; 89:2799–2808.CrossRefGoogle Scholar
  81. 81.
    Pelliccia A, Sparato A, Granata J, Biffi A, Caselli G, Alabiso A. Coronary arteries in physiological hypertrophy: Echocardiographic evidence of increased proximal size in elite athletes. Int J Sports med 1990; 11:120–126.PubMedCrossRefGoogle Scholar
  82. 82.
    Currens JH, White PD. Half century of running. Clinical, physiologic and autopsy findings in the case of Clearence De Mare “Mr. Marathoner”. N Engl J Med 1961; 265:988–993.PubMedCrossRefGoogle Scholar
  83. 83.
    Schwartz JS, Baran KW, Bache RJ. Effect of stenosis on exercise-induced dilation of large coronary arteries. Am Heart J 1990; 119:520–524.PubMedCrossRefGoogle Scholar
  84. 84.
    Dodge JT, Brown G, Bolson EL, Dodge HT. Lumen diameter of normal human coronary arteries: Influence of age, sex, anatomic variation and left ventricular hypertrophy or dilation. Circulation 1992; 86:232–246.PubMedCrossRefGoogle Scholar
  85. 85.
    Rogers PJ, Miller TD, Bauer BA, Brum JM, Bove AA, Vanhoutte PM. Exercise training and responsiveness of isolated coronary arteries. J Appl Physiol 1991; 71:2346–2351.PubMedGoogle Scholar
  86. 86.
    Muller JM, Myers PR, Langhlin MH. Vasodilator responses of coronary resistance arteries of exercise-trained pig. Circulation. 1994; 89:2308–2314.PubMedCrossRefGoogle Scholar
  87. 87.
    Laughlin MH, Oltman CL, Muller JM, Myers PR, Parker JL. Adaptation of the coronary circulation to exercise training. In cardiovascular response to exercise, CL Fletcher (ed), Mount Kisco, N.Y., Futura Publishing Co., 1994; p 175–205.Google Scholar
  88. 88.
    Parker JL, Oltman CL, Muller JM, Myers PR, Adams RH, Laughlin MH. Effect of exercise training on regulation of tone in coronary arteries and arterioles. Med Sci Sport Exerc 1994; 26:1252–1261.CrossRefGoogle Scholar
  89. 89.
    Laughlin MH. Effect of exercise training on coronary circulation: Introduction. Med Sci Sport Exerc 1994; 26:1226–1234.CrossRefGoogle Scholar
  90. 90.
    Wang J, Wollin MS, Hintze TH. Chronic exercise enhances endothelium-mediated dilation of epicardial coronary artery in conscious dogs. Circ Res 1993; 73:829–838.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Carlo Palombo
    • 1
    Email author
  • Michaela Kozàkovà
    • 1
  • Giovanni Bigalli
    • 1
  • Danilo Neglia
    • 1
  • Alessandro Distante
    • 1
  • Oberdan Parodi
    • 1
  • Antonio L’Abbate
    • 1
  1. 1.CNR Institute of Clinical PhysiologyUniversity of PisaPisaItaly

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