MORPHOLOGIC CHANGES INDUCED BY ACETYLCHOLINE INFUSION IN NORMAL AND ATHEROSCLEROTIC CORONARY-ARTERIES

Low doses of acetylcholine induce ''endothelium-dependent'' dilatation in normal coronary arteries and constriction of diseased vessels. Thi s study investigated morphologic changes induced by perfusion of norma l and diseased coronary arteries with low and high doses of acetylchol ine. Vessels were excised from a series of beating hearts explanted at transplantation for idiopathic dilated cardiomyopathy and coronary ar tery disease. Coronary arteries from other explanted hearts, perfused with saline solution under similar condition were taken as controls. S amples were studied using conventional histopathologic and immunohisto chemical methods. Coronary arteries were grouped according to presence or absence of histologically detectable structural modifications of a ny type and extent. Low doses of acetylcholine induced changes in all but 1 structurally diseased coronary artery, whereas no change was ind uced in any but 1 histologically normal coronary artery. High doses of acetylcholine induced contraction changes in both normal and diseased vessels. Changes observed in the wall of the contracted vessels were: (1) endothelial cell contraction with protruding nuclei and detachmen t of their intercellular junctions with exposure of subjacent collagen to flow, (2) contraction of plaque smooth muscle cells, (3) formation of cushions protruding into vessel lumens causing blunt microchannels . Contraction in both intimal and plaque cells occurred even in diseas ed vessel segments with intimal denudation. These effects seemed to be dose-dependent in structurally normal vessels because low doses of ac etylcholine did not produce any morphologically detectable changes in histologically normal coronary arteries, while low doses of acetylchol ine induced similar reactions in vessels affected by both atherosclero sis and subintimal fibrocellular thickening.