Decision-Making Time Cells in Hippocampal Dorsal CA1.

Sequential neural dynamics encoded by "time cells" play a crucial role in hippocampal function. However, the role of hippocampal sequential neural dynamics in associative learning is an open question. In this manuscript, we used two-photon Ca2+ imaging of dorsal CA1 pyramidal neurons in head-fixed mice performing a go-no-go associative learning task. We found that pyramidal cells responded differentially to the rewarded or unrewarded stimuli. The stimuli were decoded accurately from the activity of the neuronal ensemble, and accuracy increased substantially as the animal learned to differentiate the stimuli. Decoding the stimulus from individual pyramidal cells that responded differentially revealed that decision-making took place at discrete times after stimulus presentation. Lick prediction decoded from the ensemble activity of cells in dCA1 correlated linearly with lick behavior indicating that sequential activity of pyramidal cells in dCA1 constitutes a temporal memory map used for decision-making in associative learning.

Structural features of linear, homo-Aib-based peptides in solution: a spectroscopic and molecular mechanics investigation.

In continuation of our studies on the determination of the structural features of functionalized peptides in solution by combining time-resolved fluorescence data and molecular mechanics results, the conformational properties of a series of linear, homo-Aib peptides in methanol (a structure-supporting solvent) were investigated. These compounds have the general formula P(Aib)nN, where Aib is alpha-aminoisobutyric acid, N is naphthalene and P is the monomethylated protoporphyrin IX, the two latter chromophores being covalently attached to the peptide C- and N-termini, respectively, while n=3, 6 and 9. According to 1H NMR and IR spectra, the peptides investigated largely populate a 3(10)-helical structure in CDCl3, which is also a structure-supporting solvent. Both steady-state and time-resolved fluorescence measurements show a strong quenching of the N emission that parallels an increase of the P fluorescence intensity, suggesting the occurrence of long-range energy transfer from 1N* to ground-state P. Comparison of quenching efficiencies and lifetime pre-exponents with those obtained theoretically from the deepest energy minimum conformers is very satisfactory. The computed structures, built up by partially taking into account the solvent medium, exhibit a rigid, highly compact arrangement, owing to both the 3(10)-helix conformation of the backbone chain and the very few peptide-to-chromophore covalent linkages. As a result, only one or two stable conformations for each peptide were theoretically found, in full agreement with the time-resolved fluorescence data. Orientational effects between the probes must be taken into account for a correct interpretation of the fluorescence decay results, which implies that interconversion among conformational substates of the N linkages is slower than 10 ns, corresponding to the upper limit of the energy transfer characteristic time.

A spectroscopic and molecular mechanics investigation on a series of AIB-based linear peptides and a peptide template, both containing tryptophan and a nitroxide derivative as probes.

Linear Aib-based hexapeptides, of the general formula Ac-Toac-(Aib)(n) -Trp-(Aib)(r) -OtBu [T(Aib)(n) Trp], where n + r = 4, and Toac is a nitroxide spin-labeled C(alpha,alpha)-disubstituted glycine, were investigated by steady-state and time-resolved fluorescence measurements in different solvent media. A related peptide, i.e., cyclo-¿Orn-[(Aib)(2)-Trp-(Aib)(2)-Z]-Asp-[(Aib)(2)-Toac-(Aib)(2)-+ ++OtBu ]¿ [T-cyclo-Trp], was also studied by the same techniques. It is a L-Orn, L-Asp diketopiperazine template, to which two Aib-based chains are covalently attached, each one containing one chromophore only, i.e., Trp or Toac. Whatever the solvent, in the former series of peptides quenching of the excited Trp exhibits three lifetime components and proceeds on a time scale from subnanoseconds to a few nanoseconds, while in the case of the template the same process occurs entirely on the nanoscale time scale, exhibiting two lifetimes only. The ir absorption spectral patterns suggest that the backbone of the peptides examined is in the 3(10)-helical conformation, as earlier determined by x-ray diffraction for T(Aib)(3)Trp in the crystal state. In all cases, the fluorescence results are satisfactorily described by a dipole-dipole interaction mechanism, in which electronic energy transfer takes place from the excited Trp to Toac, provided the mutual orientation between the fluorophore and Toac is taken into account. This implies that interconversion among conformational substates is slow on the time scale of the transfer process, allowing us to estimate the dynamics of the process. Molecular mechanics calculations coupled with time decay data made it possible to build up the most probable structures of these peptides in solution.

Structural features of linear (alphaMe)Val-based peptides in solution by photophysical and theoretical conformational studies.

In continuation of our studies on the determination of the structural features of functionalized peptides in solution by combining time-resolved fluorescence data and molecular mechanics results, the conformational features of a series of linear, L-(alphaMe)Val-based peptides have been investigated in methanol. These foldamers have the general formula F[(alphaMe)Val](r)-T-[(alphaMe)Val](2)NHtBu, where (alphaMe)Val = C(alpha)-methylvaline and r = 0-3, while F [= fluoren-9-ylmethoxycarbonyl (Fmoc)] and T [= 2,2,6,6-tetramethylpiperidine-1-oxyl-4-amino-carboxylic (Toac)] are a fluorophoric N(alpha)-protecting group and a nitroxide-based alpha-amino acid quencher, respectively. According to ir and CD spectra, the longest term of the series (r = 3) attains a 3(10)-helical structure, while the other peptides populate an intramolecularly H-bonded, 3(10)-helix-like conformation affected by dynamic helical distortions, which are enhanced by the shortness of the backbone chain. Such distortions are reflected in both the energy of the stretching mode and the molar extinction coefficient of the H-bonded N-H groups, the former being higher and the latter smaller than those of a stable 3(10)-helix. Steady-state and time-resolved fluorescence measurements in methanol show a strong quenching of Fmoc by the Toac residue, located at different helix positions, depending on the r value. Comparison of quenching efficiencies and lifetime preexponents with those theoretically obtained from the deepest energy minimum conformers, assuming a Förster mechanism, is satisfactory. The computed structures exhibit a rather compact arrangement, which accounts for the few sterically favored conformations for each peptide, in full agreement with the time-resolved fluorescence data. Orientational effects between the probes must be taken into account for a correct interpretation of the fluorescence decay results, implying that interconversion among conformational substates involving the probes is slower than the energy transfer rate.

Structural versatility of peptides from C alpha, alpha-disubstituted glycines: crystal-state conformational analysis of peptides from C alpha-methylhomophenylalanine, (alpha Me) Hph.

The molecular and crystal structures of the C alpha-tetrasubstituted, delta-branched alpha-amino acid C alpha-methylhomophenylalanine, H-D-(alpha Me)Hph-OH, and three peptides (to the pentamer level), including the homotripeptide, have been determined by X-ray diffraction. The peptides are Z-L-(alpha Me)Hph-(L-Ala)2-OMe pBrBz-[D-(alpha Me)Hph]3-OtBu and Ac-(Aib)2-L-(alpha Me)Hph-(Aib)2-OtBu. All the (alpha Me)Hph residues prefer phi, psi torsion angles in the helical region of the conformational map. The two terminally blocked tripeptides adopt a beta-bend conformation stabilized by a 1<--4 C = O... H-N intramolecular H-bond. The terminally blocked pentapeptide is folded in a regular 3(10)-helix. In general, the relationship between (alpha Me)Hph alpha-carbon chirality and helix handedness is the same as that exhibited by protein amino acids. A comparison is also made with the conclusions extracted from published work on peptides from other types of C alpha-alkylated aromatic alpha-amino acids.

(S)-C alpha-ethyl, C alpha-benzylglycine [(S)-(alpha Et)Phe] peptides fold in left-handed helical structures.

The first x-ray diffraction structure analysis of a C alpha-ethyl, C alpha-benzylglycine [(alpha Et)Phe]-containing peptide, N alpha-benzyloxycarbonyl-alpha-aminoisobutyryl-alpha-amino-isobutyr yl-(S)- C alpha-benzylglycyl-alpha-aminoisobutyric acid (methanol solvate), has been performed. In the crystal state the N alpha-protected tetrapeptide is folded in an incipient, left-handed 3(10)-helical structure. This finding confirms that the relationship between (alpha Et)Phe alpha-carbon chirality and screw sense of the helix that is formed is opposite to that exhibited by protein amino acids, including Phe.

[Identification of multivessel coronary disease using myocardial Thallium-201 and dipyridamole scintigraphy in acute myocardial infarction in the thrombolytic era]. / L'identificazione della coronaropatia plurivasale mediante tomoscintigrafia miocardica con tallio-201 e dipiridamolo nell'infarto miocardico acuto nell'era trombolitica.

Recently some Authors observed a low sensitivity of submaximal exercise thallium-201 myocardial scintigraphy for predicting multivessel coronary disease in patients with recent acute myocardial infarction (AMI) treated with thrombolytic therapy. The aim of our study was to evaluate the accuracy of dipyridamole thallium-201 single photon emission computerized tomography (DIP-SPECT) for predicting the location and the extent of coronary artery disease in patients with recent uncomplicated AMI and to compare the results obtained in patients treated with thrombolytic therapy (Group T) to those obtained in patients treated with non-thrombolytic therapy (Group NT). We examined 61 consecutive patients with recent uncomplicated AMI by predischarge DIP-SPECT as well as by coronary angiography. In the Group T the total number of reversible perfusion defects per patient was 2.6 +/- 1.9 of which 2.1 +/- 1.6 at infarct site and 0.5 +/- 0.7 in other coronary territories; similarly, in the Group NT the total number of reversible perfusion defects per patient was 2.5 +/- 1.6 (NS compared to Group T) of which 1.9 +/- 1.2 (NS compared to Group T) at infarct site and 0.5 +/- 0.8 (NS compared to Group T) in other coronary territories. In Group T, DIP-SPECT demonstrated a sensitivity of 84% with specificity of 60% for predicting critical (> or = 70%) stenoses at infarct site as well as a sensitivity of 54% with specificity of 54% in the other coronary territories (data are expressed in number of patients per cent). The sensitivity and specificity observed in Group NT did not differ significantly from those of Group T.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic responses to seated and supine lower body negative pressure: comparison with +Gz acceleration.

Hemodynamic changes between upright and supine lower body negative pressure (LBNP) to levels of -70 mm Hg were compared in 8 subjects (5 males, 3 females) and correlated with their findings during simulated Shuttle reentry acceleration with a slow onset rate of 0.002 G/s (1,020 s to peak +2 Gz) and during gradual onset exposures (0.03 G/s) to +3 Gz and +4 Gz. Six of the 8 subjects were able to tolerate 2 min at peak +2 Gz, 2-5 min at +3 Gz, and 1-2 min at +4 Gz. Heart rate (HR) at any given level of upright LBNP regularly exceeded supine levels. HR change at -50 mm Hg in upright subjects (+47.7 bpm from 74.1 +/- 1.9 (M +/- S.E.) bpm, control) was 2.6 times greater than in supine subjects (+18.3 bpm from 64.8 +/- 2.8 bpm, control). HR values at -40 mm Hg supine (73.7 +/- 2.6) matched seated upright pre-LBNP control levels (74.1 +/- 1.9 bpm), while values at -70 mm Hg supine (102.5 +/- 4.4 bpm) were not significantly different from those at -40 mm Hg upright (103.1 +/- 4.0 bpm). Peak HR during +3 Gz (145.8 +/- 7.7 bpm) and +4 Gz (152.3 +/- 6.5 bpm) significantly exceeded recorded supine and upright LBNP levels, whereas values at +2 Gz (104.8 +/- 5.5 bpm) closely matched those at -40 mm Hg upright (103.1 +/- 4.0 bpm) and -70 mm Hg supine (102.5 +/- 4.4 bpm). Supine LBNP HR changes in this relatively small group of subjects closely matched those previously reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary adrenergic hyperreactivity in patients with syndrome X and abnormal electrocardiogram at rest.

Syndrome X is characterized by an abnormal vasomotility of coronary microvessels. It is unknown whether the presence of an ischemic-like pattern in the electrocardiogram at rest (T-wave inversion) reflects a more severe vasomotion disturbance. Changes in coronary sinus flow (thermodilution) and epicardial vessel diameter (quantitative angiography) during adrenergic activation were measured with a standard cold pressor test in patients with syndrome X whose electrocardiogram at rest was normal (group 1: 17 patients) or showed stable, symmetrically inverted T waves (group 2: 22 patients). Cold pressor test increased mean blood pressure and rate-pressure product to a similar extent in both groups, increased coronary sinus flow in group 1 (88 +/- 29 to 119 +/- 36 ml/min; p less than 0.05) and not in group 2 (109 +/- 37 vs 104 +/- 36 ml/min; p = not significant), and decreased coronary resistance in group 1 (1.38 +/- 0.42 to 1.19 +/- 0.38 mm Hg/ml/min; p less than 0.05) and augmented it in group 2 (1.06 +/- 0.32 to 1.28 +/- 0.43 mm Hg/ml/min; p less than 0.02). During cold stimulus, the proximal and middle segments of epicardial arteries showed negligible changes in their lumen, whereas the distal segment dilated in group 1 (1.81 +/- 0.27 to 2.01 +/- 0.32 mm; p less than 0.05) and constricted in group 2 (1.82 +/- 0.12 to 1.62 +/- 0.20 mm; p less than 0.05). Differences in coronary hemodynamic and angiographic responses between the groups were statistically significant (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[The functional capacity of the coronary circulation in myocardial hypertrophy]. / Capacità funzionale del circolo coronarico nell'ipertrofia miocardica.

Experimental studies showed anatomic and functional abnormalities in coronary circulation of hypertensive hypertrophic hearts. Epidemiologic and clinical data suggest that hypertensive patients with myocardial hypertrophy are more prone or sensitive to myocardial ischemia. Although several factors have been invoked to explain these observations, pathophysiological abnormalities in coronary circulation of hypertrophied hearts due to pressure overload in man are unsettled. Recently we evaluated coronary flow, through thermodilution, during progressive reduction of perfusion pressure in hypertensive patients with and without left ventricular hypertrophy. While in hypertensives with normal left ventricular mass, no significant changes of coronary flow were observed during reduction of perfusion pressure until 70 mmHg were reached, in patients with myocardial hypertrophy coronary flow began to decrease at 90 mmHg. Meanwhile, a small but significant increase of oxygen myocardial extraction was recorded at 75 and 70 mmHg. These data suggest that even in man when hypertension and hypertrophy are concomitant, the lower range of coronary autoregulation is shifted to a higher perfusion pressure and that under these conditions, the myocardium may be vulnerable to treatment-induced relative hypotension.

Angiographic evolution of coronary atherosclerosis in patients receiving propranolol. A two-year follow-up.

STUDY OBJECTIVE: To test whether propranolol may influence the progression of coronary atherosclerosis. DESIGN: Repeat coronary angiography after two year treatment and evaluation of changes in coronary narrowings. SETTING: Subjects with effort angina of recent onset requiring coronary angiography and medical treatment. PATIENTS: 80 untreated patients, with a greater than or equal to 50 percent focal narrowing on a major coronary branch associated or not with a less than 50 percent stenosis of other major branches. They were randomized to isosorbide dinitrate (40 mg bid) (group 1, control group) or to propranolol (80 mg qid) (group 2, treatment group). RESULTS: At restudy, there were more diseased vessels and These narrowings per patient in both groups. Multivessel involvement and greater than or equal to 50 percent obstructions were also augmented. These changes were not statistically significant. Patients with progression of the stenotic tracts (both greater than or equal to 50 percent and less than 50 percent were 19 (48 percent) in group 1 and 28 (70 percent) in group 2 (p less than 0.05). Narrowings with progression were 25 in group 1 and 48 in group 2. Thirteen narrowings in group 1 and 15 in group 2 were newly detected at restudy. Eighteen patients (45 percent) in group 1 and nine (23 percent) in group 2 had a steady disease. Smoking, high blood pressure, family history of coronary disease, blood glucose values and lipid levels were considered; the only significant group differences were 31 percent rise of total triglyceride and 23 percent decrease of HDL cholesterol in patients who were treated with propranolol. CONCLUSIONS: Propranolol showed an adverse influence on coronary atherosclerosis, regarding the evolution of both greater than or equal to 50 percent and less than 50 percent narrowings and not the formation of new stenoses. Changes in serum lipid values might have a role.

Coronary angiographic patterns in hypertensive compared with normotensive patients.

Patients in this study were assessed by coronary angiography because of classic effort angina and a positive exercise test. Of these patients, 320 had untreated primary hypertension and 320, similar in age and gender distribution, were normotensive. In all patients coronary angiography documented that at least one major epicardial branch was restricted by 50% or more. Prevalence of single- and double-vessel disease in the fourth and fifth decades of life was similar in the two populations and in both tended to decline with age. Prevalence of triple-vessel disease was also similar in the two populations in the fourth and fifth decades; in either population it rose with age and reached a peak at the seventh decade of life. The percentages of hypertensive patients in the sixth and seventh decades with triple-vessel disease was significantly (p less than 0.01) greater (40% and 50%, respectively) than the corresponding values in normotensive individuals (25% and 31%, respectively). The left main coronary artery was not significantly more involved in the high blood pressure group. Pressure was moderately and similarly raised at any age in hypertension; serum cholesterol and triglyceride levels, blood glucose, and smoking habits were comparable in the two populations. These results suggest that hypertension does not accelerate the appearance of significant coronary narrowing or multiple vessel involvement. Starting from the sixth decade, the natural age-related evolution of coronary disease seems to be aggravated in hypertensive subjects, as reflected by an augmented number of diseased vessels. This process is probably related to high blood pressure in itself; whether the severity of hypertension might also exert an influence is not deducible from this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle.

BACKGROUND: At any given perfusion pressure, coronary reserve is expressed by the difference between autoregulated and maximally vasodilated flow. In hypertension the raised coronary resistance reduces the steepness of the pressure-flow relationship at maximal vasodilatation. In the presence of cardiac hypertrophy the line of autoregulated flow becomes higher. For these reasons coronary reserve is reduced and the point at which baseline flow approaches the maximal achievable flow might be shifted to a higher perfusion pressure. Thus, any reduction below this elevated and critical value of pressure would lower the coronary flow. METHODS AND RESULTS: The investigated patients were normotensive (controls, nine) and hypertensive with normal (group I, seven) or augmented LV mass index because of concentric LV hypertrophy (group II, eight). All had effort-induced angina and angiographically normal left epicardial branches. Flow in the great cardiac vein was measured by thermodilution in the baseline and during stepwise (5 mm Hg every 5 minutes) decrease of the coronary perfusion pressure with a titrated nitroprusside i.v. infusion; perfusion pressures of 60 mm Hg in the controls and 70 mm Hg in the hypertensives were taken as end points. Baseline flow averaged 102 ml/min in normotensives, 104 ml/min in hypertensive group I and 148 ml/min in hypertensive group II. At the end points flow was similar to baseline in the controls and group I. In group II coronary flow started to decline and myocardial O2 extraction started to slightly but significantly rise at perfusion pressures of 90-80 mm Hg; at the end point flow was reduced by 26% (p less than 0.01 from baseline). The perfusion patterns did not seem to be related to the changes in tension-time index and heart rate. CONCLUSIONS: The association of high blood pressure (reduced ability of the coronary arterioles to dilate) and hypertrophy of the myocardium (augmented baseline coronary flow) may shift the point of exhaustion of coronary reserve to a higher perfusion pressure and make the myocardium vulnerable to treatment-induced relative hypertension.

Acute and chronic efficacy of felodipine in congestive heart failure.

In 13 patients with congestive heart failure we tested the acute hemodynamic effects of 5 vs. 10 mg felodipine tablets, in a double-blind, cross-over study. One hour after felodipine 5 mg, echocardiographic ejection fraction (%), cardiac index (thermodilution-ml/min/m2), and pulmonary wedge pressure (mm Hg) significantly changed (from 21 +/- 2 to 26 +/- 2, 2350 +/- 150 to 2790 +/- 160, 24 +/- 4 to 17 +/- 4) while they remained steady after felodipine 10 mg. The greatest stroke index increases were associated with felodipine 5 mg in 12 patients and 10 mg in 1 patient. Therefore we evaluated (open study) the long-term (2 months- 1 year) clinical and hemodynamic efficacy following the treatment with the acutely most effective dose (twice daily). After 2 months ejection fraction, cardiac index and pulmonary wedge pressure were respectively 24 +/- 2, 2550 +/- 150, and 18 +/- 4 (12 hours after the last drug administration, n = 11, P less than 0.02 from baseline). These parameters further increased one to two hours after the following administration of felodipine. Clinical improvement (reduction of 1 functional class, according to the New York Heart Association) was observed in 8/13 patients. These 8 patients participated to the one year follow-up. In 5 patients follow-up was interrupted because of acute cardiovascular events. However, before study interruption (5 patients) or ending (3 patients) clinical status did not worsen and ejection fraction remained higher than in the pretreatment period. Therefore, low dose felodipine might be used in the treatment of congestive heart failure.

[Acute coronary vasomotor effects of nifedipine and its therapeutic efficacy in syndrome X]. / Effetti vasomotori coronarici acuti della nifedipina ed efficacia terapeutica nella sindrome X.

In 18 patients (12 females) presenting with effort-induced chest pain and normal coronary angiograms (syndrome X), 10 mg sublingual nifedipine increased the lumen of major coronary arteries (quantitative angiography) by 13% +/- 10 (p less than 0.01), coronary blood flow (thermodilution) by 23% +/- 26 (p less than 0.05), norepinephrine plasma concentration by 60% +/- 42 (p less than 0.01), and reduced the global ST segment shift during the effort stress test from 8.8 +/- 4.1 to 7 +/- 6.8 mm (p less than 0.03) at comparable maximal workload and at unchanged double product. There was a correlation (positive) of changes in flow with changes in coronary lumen diameter (r = 0.65, p less than 0.01), with ST segment response to exercise (r = 0.83, p less than 0.001), and with (inverse) norepinephrine plasma concentration (r = -0.70, p less than 0.01); no correlation was found between ST segment response and changes in arterial lumen diameter. In a few cases nifedipine did not improve or even worsened the response to exercise; in them coronary flow was unchanged or reduced and norepinephrine plasma levels were modestly or greatly increased, respectively. After 4-week treatment with nifedipine (10-20 mg 4 times daily), the effort ST segment shift was further diminished to 4.4 +/- 3.5 mm (p less than 0.03) despite a slightly increased double product. Plasma norepinephrine values, as compared to those following acute nifedipine, were reduced by 40% in patients with further improvement and unchanged in patients whose exercise performance did not vary.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary vasomotor equivalents in the electrocardiographic behavior in induced ischemia]. / Corrispettivi vasomotori coronarici del comportamento elettrocardiografico nella ischemia indotta.

In effort angina the exercise test can shift the ST-segment during the active phase and/or recovery. To investigate whether coronary vasomotility has some part in these electrocardiographic patterns, in 15 patients with stable effort angina we performed a quantitative angiographic evaluation of single, significant coronary stenoses (greater than 50%) during: spontaneous rhythm, graded atrial pacing (max 160 b/min) and at 1-3-5 min of recovery, both without drugs and after Ca-blockade (nifedipine, 10 mg sl). The greatest ST changes were at peak of the pacing in 9 patients (Group 1) and at recovery in 6 (Group 2). In each patient the stenotic lumen was reduced by atrial pacing (-9%, p less than 0.03); in Group 1 the lumen recovered soon after the end of the pacing, whereas in Group 2 narrowings became greater (-17%, p less than 0.02) at about 3 min of the recovery phase. In both groups nifedipine did not prevent the enhancement of the stenosis during pacing, but avoided constriction and ST changes during recovery in Group 2. Thus, in effort angina a superimposed active vasoconstriction contributes to the increase of the ST changes during the recovery phase of the exercise.

Acute coronary vasomotor effects of nifedipine and therapeutic correlates in syndrome X.

In 18 patients (12 women) presenting with effort-induced chest pain and normal coronary angiograms (syndrome X), 10 mg sublingual nifedipine increased the lumen of major coronary arteries (quantitative angiography) by 13 +/- 10% (p less than 0.01), coronary blood flow (thermodilution) by 23 +/- 26% (p less than 0.05), norepinephrine plasma concentration by 60 +/- 42% (p less than 0.01) and decreased the global ST-segment shift during the effort stress test from 8.8 +/- 4.1 to 7 +/- 6.8 mm (p less than 0.03) at comparable maximal workload and at unchanged double product. There was a correlation (positive) of changes in flow with changes in coronary lumen diameter (r = 0.65, p less than 0.01) with ST-segment response to exercise (r = 0.83, p less than 0.001) and with (inverse) norepinephrine plasma concentration (r = -0.70, p less than 0.01); no correlation was found between ST-segment response and changes in arterial lumen diameter. In a few cases, nifedipine did not improve or even worsened the response to exercise; coronary flow was unchanged or decreased and norepinephrine plasma levels were modestly or greatly increased, respectively. After 4 weeks of treatment with nifedipine (10 to 20 mg 4 times daily), the effort ST-segment shift was further decreased to 4.4 +/- 3.5 mm (p less than 0.03) despite a slightly increased double product. Plasma norepinephrine values, as compared to those after acute nifedipine, were decreased by 40% in patients with further improvement and were unchanged in patients whose exercise performance did not vary.(ABSTRACT TRUNCATED AT 250 WORDS)

[The flow-pressure relationship in coronary perfusion in myocardial hypertrophy in hypertension]. / Relazione flusso-pressione di perfusione coronarica nel miocardio ipertrofico dell'iperteso.

For any given perfusion pressure the difference between coronary autoregulated and maximally vasodilated flow represents the flow reserve. If hypertension and cardiac hypertrophy are present, the line of autoregulated flow becomes higher, and the pressure-flow relationship at maximal vasodilation less steep, due to the raised resistance. In these circumstances, flow reserve reduces and the point at which rest flow equals maximal achievable flow may be shifted to a higher perfusion pressure. Thus, flow would decline even if the perfusion pressure is lowered to normal. We tested this point in a setting of patients having chest pain and normal angiography of the left epicardial branches. Baseline flow (ml/min) from the great cardiac vein (thermodilution) was 142 +/- 13 in 9 normotensives (controls), 144 +/- 15 in 7 hypertensives (Group 1) with normal (114 +/- 11 g) left ventricular mass index and 188 +/- 17 in 8 hypertensives (Group 2) whose left ventricular mass (171 +/- 24 g) exceeded the mean +2 SD of normal. Coronary perfusion pressure was lowered in these patients by 5 mmHg every 5 minutes with a titrated nitroprusside infusion, taking as endpoints a perfusion pressure of 60 mmHg in the controls and of 70 mmHg in hypertensives. At endpoints, flow was similar to baseline in controls and Group 1. In Group 2 flow started to decline and myocardial oxygen extraction to slightly but significantly rise at perfusion pressure of from 90 to 80 mmHg; at the endpoint flow was reduced by 26% of baseline (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Various clinical and vasomotor coronary responses to calcium block in mixed angina and Prinzmetal's angina, expression of various physiopathologic mechanisms]. / Differente risposta clinica e vasomotoria coronarica al calcio-blocco nell'angina mista e nell'angina tipo Prinzmetal, espressione di un diverso meccanismo fisiopatologico.

Impedance to flow due to coronary spasm is currently interpreted as the mechanism of Prinzmetal angina. Flow impedance, probably of vasomotor origin, superimposed on severe coronary stenosis is also viewed as the trigger for the spontaneous component of mixed angina. The major question that we attempted to answer in this study was whether mixed angina may be considered a variant of the Prinzmetal form, or a particular manifestation of the classic effort form. For these purposes we investigated the acute vasomotor response to calcium channel blockade (nifedipine 10 mg sl) of both significant (greater than 50%) stenotic lesions and of normal coronary vessels in 22 patients with mixed angina and in 14 patients with Prinzmetal angina, and correlated it with the clinical response to treatment (nifedipine 20 mg qid). Calcium channel blockade, in fact, is considered as a specific remedy in the presence of an altered coronary vasomotility. The clinical response was evaluated through ambulatory Holter monitorings of 48 hour duration, while on placebo, nifedipine and placebo again. In mixed angina an angiographic evaluation showed that the residual lumen diameter of significant lesions was unchanged in 2, enhanced in 11 and reduced in 9 patients after sl nifedipine; lumen variations from base line ranged from +1.5 to -1.3 mm. Acute stenosis widening or narrowing correlated closely with the efficacy or not of the treatment. In the Prinzmetal group the vast majority of the lesions had compliant portions which invariably responded with dilatation (the residual coronary lumen increased by an average of 69% of base line); 100% of patients in this group responded favourably to treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Angiographic course of coronary atherosclerosis in angina pectoris. Its relation to 2 years' treatment with propranolol, nifedipine and nitrates]. / Evoluzione angiografica dell'aterosclerosi coronarica nell'angina pectoris. Relazione con il trattamento per 2 anni con propranololo, nifedipina e nitrati.

Calcium antagonists and beta-blockers may retard or inhibit atherogenesis. We tested whether nifedipine or propranolol may retard or induce regression of coronary atherosclerosis in man. In selected population of 113 patients with effort angina and proven coronary artery disease, the coronary cineangiographic pattern after 2 year therapy with nifedipine (Group 1, 39 patients), propranolol (Group 2, 36 patients), or isosorbide dinitrate (control group, 38 patients) was compared to the pre-treatment pattern. After 2 years the disease evolved to a different extent in the 3 groups. The number of lesions with evidence of progression was significantly smaller after nifedipine (14), and larger after propranolol (39) as compared with controls (24). Patients with evidence of progression of old lesions, and appearance of new lesions were significantly fewer in Group 1 than in Group 2 and in control patients. Thus, nifedipine seemed more protective than either of the other drugs against coronary atherosclerosis. The coronary risk factors were within normal limits in the nifedipine treated group and remained so with treatment supporting that they were likely dissociated from influences on atherosclerosis. The evolution, at least as judged by the number of lesions with progression, appeared significantly (p less than 0.01) worse with propranolol than with isosorbide dinitrate. This may prospect that nitrate contrasted the evolution of the disease, or that propranolol made it worse, possibly through unfavourable modifications of serum lipids (28% rise of total triglyceride and 25% decrease of HDL cholesterol were already detectable at 12 months in Group 2).