Affiliation:
1. From The Heart Institute (S.V.G., M.D.N., F.R., X.T., R.G.V) and Department of Internal Medicine (J.L., J.J.), Cedars-Sinai Medical Center, Los Angeles, CA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland (J.T.B., J.R.L.); and Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA (R.M.E.).
Abstract
Background—
Cocaine is a major cause of acute coronary syndrome, especially in young adults; however, the mechanistic underpinning of cocaine-induced acute coronary syndrome remains limited. Previous studies in animals and in patients undergoing cardiac catheterization suggest that cocaine constricts coronary microvessels, yet direct evidence is lacking.
Methods and Results—
We used myocardial contrast echocardiography to test the hypothesis that cocaine causes vasoconstriction in the human coronary microcirculation. Measurements were performed at baseline and after a low, nonintoxicating dose of intranasal cocaine (2 mg/kg) in 10 healthy cocaine-naïve young men (median age, 32 years). Postdestruction time-intensity myocardial contrast echocardiography kinetic data were fit to the equation y=A(1−e
−βt
) to quantify functional capillary blood volume (A), microvascular flow velocity (β), and myocardial perfusion (A×β). Heart rate, mean arterial pressure, and left ventricular work (2-dimensional echocardiography) were measured before and 45 minutes after cocaine. Cocaine increased mean arterial pressure (by 14±2 mm Hg [mean±SE]), heart rate (by 8±3 bpm), and left ventricular work (by 50±18 mm Hg·mL
−1
·bpm
−1
). Despite the increases in these determinants of myocardial oxygen demand, myocardial perfusion decreased by 30% (103.7±9.8 to 75.9±10.8 arbitrary units [AU]/s;
P
<0.01) mainly as a result of decreased capillary blood volume (133.9±5.1 to 111.7±7.7 AU;
P
<0.05) with no significant change in microvascular flow velocity (0.8±0.1 to 0.7±0.1 AU).
Conclusions—
In healthy cocaine-naïve young adults, a low-dose cocaine challenge evokes a sizeable decrease in myocardial perfusion. Moreover, the predominant effect is to decrease myocardial capillary blood volume rather than microvascular flow velocity, suggesting a specific action of cocaine to constrict terminal feed arteries.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
23 articles.
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