Cocaine-induced vasoconstriction in the human coronary microcirculation

New evidence from myocardial contrast echocardiography

Swaminatha V. Gurudevan, Michael D. Nelson, Florian Rader, Xiu Tang, Joshua Lewis, Jimmy Johannes, J. Todd Belcik, Robert M. Elashoff, Jonathan Lindner, Ronald G. Victor

    Research output: Contribution to journalArticle

    14 Citations (Scopus)

    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) 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·bpm). 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

    Original languageEnglish (US)
    Pages (from-to)598-604
    Number of pages7
    JournalCirculation
    Volume128
    Issue number6
    DOIs
    StatePublished - Aug 6 2013

    Fingerprint

    Microcirculation
    Vasoconstriction
    Cocaine
    Echocardiography
    Acute Coronary Syndrome
    Arterial Pressure
    Perfusion
    Heart Rate
    Cardiac Catheterization
    Microvessels
    Blood Volume
    Young Adult
    Oxygen

    Keywords

    • cocaine
    • echocardiography
    • microcirculation
    • myocardial perfusion imaging

    ASJC Scopus subject areas

    • Physiology (medical)
    • Cardiology and Cardiovascular Medicine

    Cite this

    Gurudevan, S. V., Nelson, M. D., Rader, F., Tang, X., Lewis, J., Johannes, J., ... Victor, R. G. (2013). Cocaine-induced vasoconstriction in the human coronary microcirculation: New evidence from myocardial contrast echocardiography. Circulation, 128(6), 598-604. https://doi.org/10.1161/CIRCULATIONAHA.113.002937

    Cocaine-induced vasoconstriction in the human coronary microcirculation : New evidence from myocardial contrast echocardiography. / Gurudevan, Swaminatha V.; Nelson, Michael D.; Rader, Florian; Tang, Xiu; Lewis, Joshua; Johannes, Jimmy; Todd Belcik, J.; Elashoff, Robert M.; Lindner, Jonathan; Victor, Ronald G.

    In: Circulation, Vol. 128, No. 6, 06.08.2013, p. 598-604.

    Research output: Contribution to journalArticle

    Gurudevan, SV, Nelson, MD, Rader, F, Tang, X, Lewis, J, Johannes, J, Todd Belcik, J, Elashoff, RM, Lindner, J & Victor, RG 2013, 'Cocaine-induced vasoconstriction in the human coronary microcirculation: New evidence from myocardial contrast echocardiography', Circulation, vol. 128, no. 6, pp. 598-604. https://doi.org/10.1161/CIRCULATIONAHA.113.002937
    Gurudevan, Swaminatha V. ; Nelson, Michael D. ; Rader, Florian ; Tang, Xiu ; Lewis, Joshua ; Johannes, Jimmy ; Todd Belcik, J. ; Elashoff, Robert M. ; Lindner, Jonathan ; Victor, Ronald G. / Cocaine-induced vasoconstriction in the human coronary microcirculation : New evidence from myocardial contrast echocardiography. In: Circulation. 2013 ; Vol. 128, No. 6. pp. 598-604.
    @article{655be172eff347598a857cdbfda31070,
    title = "Cocaine-induced vasoconstriction in the human coronary microcirculation: New evidence from myocardial contrast echocardiography",
    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-na{\"i}ve young men (median age, 32 years). Postdestruction time-intensity myocardial contrast echocardiography kinetic data were fit to the equation y=A(1-e) 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·bpm). 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",
    keywords = "cocaine, echocardiography, microcirculation, myocardial perfusion imaging",
    author = "Gurudevan, {Swaminatha V.} and Nelson, {Michael D.} and Florian Rader and Xiu Tang and Joshua Lewis and Jimmy Johannes and {Todd Belcik}, J. and Elashoff, {Robert M.} and Jonathan Lindner and Victor, {Ronald G.}",
    year = "2013",
    month = "8",
    day = "6",
    doi = "10.1161/CIRCULATIONAHA.113.002937",
    language = "English (US)",
    volume = "128",
    pages = "598--604",
    journal = "Circulation",
    issn = "0009-7322",
    publisher = "Lippincott Williams and Wilkins",
    number = "6",

    }

    TY - JOUR

    T1 - Cocaine-induced vasoconstriction in the human coronary microcirculation

    T2 - New evidence from myocardial contrast echocardiography

    AU - Gurudevan, Swaminatha V.

    AU - Nelson, Michael D.

    AU - Rader, Florian

    AU - Tang, Xiu

    AU - Lewis, Joshua

    AU - Johannes, Jimmy

    AU - Todd Belcik, J.

    AU - Elashoff, Robert M.

    AU - Lindner, Jonathan

    AU - Victor, Ronald G.

    PY - 2013/8/6

    Y1 - 2013/8/6

    N2 - 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) 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·bpm). 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

    AB - 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) 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·bpm). 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

    KW - cocaine

    KW - echocardiography

    KW - microcirculation

    KW - myocardial perfusion imaging

    UR - http://www.scopus.com/inward/record.url?scp=84881190285&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84881190285&partnerID=8YFLogxK

    U2 - 10.1161/CIRCULATIONAHA.113.002937

    DO - 10.1161/CIRCULATIONAHA.113.002937

    M3 - Article

    VL - 128

    SP - 598

    EP - 604

    JO - Circulation

    JF - Circulation

    SN - 0009-7322

    IS - 6

    ER -