Effect of diltiazem on coronary flow reserve in patients with microvascular angina

被引:81
作者
Sutsch, G
Oechslin, E
Mayer, I
Hess, OM
机构
[1] Department of Internal Medicine, Division of Cardiology, University Hospital, CH-8091 Zürich
关键词
microvascular angina; coronary flow reserve; coronary sinus thermodilution; dipyridamole; diltiazem;
D O I
10.1016/0167-5273(95)02458-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Microvascular angina is characterized by ischemia-like symptoms in patients with normal coronary arteries and reduced coronary flow reserve. Clinical observations suggested an improvement in clinical symptomatology and exercise tolerance after treatment with calcium antagonists. The effect of diltiazem on coronary flow reserve was evaluated in controls and in patients with microvascular angina. Coronary flow reserve was measured in 16 normotensive patients (7 females, 9 males, mean age 51 +/- 10 years) with angiographically normal coronary arteries. Coronary blood flow was determined at rest, after dipyridamole (0.5 mg/kg) and following intravenous administration of diltiazem (10 mg) using coronary sinus thermodilution technique. Coronary flow reserve was calculated as coronary blood flow after dipyridamole divided by coronary blood flow at rest. Patients with normal coronary flow reserve (coronary flow reserve > 2.0) received either dipyridamole alone (group 1, controls, n = 6) or dipyridamole and diltiazem (group 2, n = 5), whereas patients with reduced coronary flow reserve (coronary flow reserve < 2.0) obtained dipyridamole and diltiazem (group 3, n = 5). Resting coronary flow was identical in the three groups, but after maximal vasodilation with dipyridamole, coronary flow increased significantly more in groups 1 and 2 than in group 3 (P < 0.05, analysis of variance (ANOVA)). Coronary flow reserve was 2.5 in group 1 and 2.3 in group 2, but was significantly reduced in group 3 (1.3; P < 0.05, ANOVA). Intravenous diltiazem failed to increase coronary blood flow in groups 2 and 3. Therefore, diltiazem does not improve reduced coronary flow reserve in patients with microvascular angina, but leaves coronary flow reserve unaffected. The failure to ameliorate impaired coronary flow reserve with diltiazem is in contrast to the reported clinical improvement after calcium channel blockade in these patients. Thus, other factors such as structural abnormalities in the microcirculation or functional abnormality in smooth muscle relaxation not responsive to calcium channel blockade are probably responsible for the occurrence of myocardial ischemia in patients with microvascular angina.
引用
收藏
页码:135 / 143
页数:9
相关论文
共 37 条
[31]   THE EFFECT OF DILTIAZEM ON CORONARY FLOW RESERVE IN HUMANS [J].
ROSSEN, JD ;
SIMONETTI, I ;
MARCUS, ML ;
BRAUN, P ;
WINNIFORD, MD .
CIRCULATION, 1989, 80 (05) :1240-1246
[32]   CORONARY DILATION WITH STANDARD DOSE DIPYRIDAMOLE AND DIPYRIDAMOLE COMBINED WITH HANDGRIP [J].
ROSSEN, JD ;
SIMONETTI, I ;
MARCUS, ML ;
WINNIFORD, MD .
CIRCULATION, 1989, 79 (03) :566-572
[33]  
SUTSCH G, 1992, J AM COLL CARDIOL, V20, P78
[34]   REGIONAL CORONARY HEMODYNAMIC-EFFECTS OF DILTIAZEM IN MAN [J].
VIGORITO, C ;
GIORDANO, A ;
DECAPRIO, L ;
CANONICO, V ;
FERRARO, P ;
FARESE, N ;
SILVESTRI, P ;
CATANZARO, M ;
RENGO, F .
AMERICAN HEART JOURNAL, 1988, 116 (03) :799-805
[35]   CORONARY VASOMOTOR RESPONSE TO ACETYLCHOLINE RELATES TO RISK-FACTORS FOR CORONARY-ARTERY DISEASE [J].
VITA, JA ;
TREASURE, CB ;
NABEL, EG ;
MCLENACHAN, JM ;
FISH, RD ;
YEUNG, AC ;
VEKSHTEIN, VI ;
SELWYN, AP ;
GANZ, P .
CIRCULATION, 1990, 81 (02) :491-497
[36]   IMPAIRED ENDOTHELIUM-DEPENDENT CHOLINERGIC CORONARY VASODILATION IN PATIENTS WITH ANGINA AND NORMAL CORONARY ARTERIOGRAMS [J].
VRINTS, CJM ;
BULT, H ;
HITTER, E ;
HERMAN, AG ;
SNOECK, JP .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 19 (01) :21-31
[37]   CORONARY HEMODYNAMICS AND CORONARY FLOW RESERVE AFTER INTRACORONARY DILTIAZEM IN HUMANS [J].
VROLIX, MC ;
SIONIS, D ;
PIESSENS, JH ;
VANLIERDE, J ;
WILLEMS, JL ;
DEGEEST, H .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 68 (17) :1633-1637