Volume 119

PTCA in silent ischemia

Number 4

7. Langou RA, Huang EK, Kelley MJ, Cohen LS. Predictive accuracy of coronary artery calcification and abnormal exercise test for coronary artery disease in asymptomatic men. Circulation 1980;62:1196-203. 8. Bergin P, Myler RK, Shaw RE, Stertzer SH, Clark DA, Ryan C, Murphy MC. Transluminal coronary angioplasty in the treatment of silent ischemia. Cathet Cardiovasc Diagn 1988;15:223-8. 9. Klein LW, Weintraub WS, Agarwal JB, Schneider RM, seelaus BS, Katz RI, Helfant RH. Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery. Am J Cardiol 1986;58:42-6.

10. Ringqvist I, Fisher LD, Mock M, Davis KB, Wedel H, Chaitman RB, Passamani E, Russel RO, Alderman EL, Kouchoukas NT, Kaiser GC, Ryan TJ, Killip T, Fray D. Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS). J Clin Invest 1983;71:1854-66. 11. Schuster EH, Griffith LSI Bulkley BH. Preponderance of acute proximal left anterior descending coronary arterial lesions in fatal myocardial infarction: a clinicopathologic study. Am J Cardiol 1981;47:1189-96.

Circulating immunoreactive endothelin in ischemic heart disease Circulating immunoreactive endothelin (ir-ET) was measured in nine patients with acute myocardial infarction (AMI), 10 patients with stable angina pectoris (SAP), and 25 normal control subjects. In patients with AMI, the plasma ir-ET level was elevated in the acute phase and was highest on the day of onset (AMh 3.8 • 1.7 pg/ml, normal control value: 0.5 _+ 0.2 pg/ml). The plasma ir-ET level showed a positive correlation with the wall motion abnormality index (rs - 0.56, p < 0.01), thrombin-anUthrombin III complex (rs = 0.55, p < 0.01), and beta thromboglobulin (rs 0.39, p < 0.05). An especially high plasma ir-ET level was detected in patients in whom the Killip subset was IV. The plasma ir-ET level was not increased in patients with SAP (0.8 • 0.3 pg/ml). The plasma ir-ET level is increased in the acute phase of AMI. A pathophysiologic state characterized by cardiac dysfunction, a n activated coagulation system, and platelet hyperactivity may be associated with this increase in plasma ir-ET. (AM HEART J 1990;119:801.)

M i t s u t a k a Yasuda, MD, M a s a k a z u Kohno, MD, Akira T a h a r a , MD, Hiroshi Itagane, M D , I k u T o d a , MD, K a n a m e Akioka, MD, M a s a k a z u Teragaki, MD, H i s a o Oku, MD, K a z u h i d e T a k e u c h i , MD, and T a d a n a o T a k e d a , MD. Osaka, J a p a n

Since F u r c h g o t t a n d Zawadzki 1 first p r o p o s e d the existence of an e n d o t h e l i u m - d e r i v e d relaxing factor in 1980, the i m p o r t a n c e of the e n d o t h e l i u m in the regulation of vascular t o n e has been recognized with increasing f r e q u e n c y f i 3 P a l m e r et al. 4 r e p o r t e d t h a t the e n d o t h e l i u m - d e r i v e d relaxing factor was nitric oxide. On the o t h e r hand, the existence of an endoth e l i u m - d e r i v e d c o n t r a c t i n g factor t h a t regulates vasoconstriction has also b e e n proposed. R e c e n t l y YanFrom the First Department of Internal Medicine, Osaka City University Medical School. Received for publication Oct. 16, 1989; accepted Nov. 7, 1989. Reprint requests: Mitsutaka Yasuda, MD, First Department of Internal Medicine, Osaka City University Medical School, 1-5-7, Asahi-maehi, Abeno-ku, Osaka 545, Japan. 4/1/18526

agisawa et al. 5 identified an e n d o t h e l i u m - d e r i v e d p e p t i d e t e r m e d endothelin, which is an e x t r e m e l y p o t e n t vasoconstrictor of vascular s m o o t h muscle in vitro a n d p r o f o u n d l y affects blood pressure a n d vascular resistance in vivo. 611 However, only limited clinical d a t a on p l a s m a e n d o t h e l i n levels are available at present. P e t e r and D u n c a n 12 showed elevated levels of circulating i m m u n o r e a c t i v e endothelin (irE T ) in p a t i e n t s in cardiogenic shock a n d in p a t i e n t s receiving chronic dialysis. T o d a t e t h e r e have b e e n no r e p o r t s on p l a s m a endothelin levels in p a t i e n t s with ischemic h e a r t disease. T h e r e f o r e we m e a s u r e d i r - E T levels in p a t i e n t s with acute m y o c a r d i a l infarction (AMI) a n d stable angina pectoris (SAP) a n d c o m p a r e d t h e m with those in n o r m a l control subjects.

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Circulating immunoreactive endothelin in ischemic heart disease.

Circulating immunoreactive endothelin (ir-ET) was measured in nine patients with acute myocardial infarction (AMI), 10 patients with stable angina pec...
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