Vassanelli C, Menegatti G, Marini A, Beltrame F, Molinari J, Cemin R
Service of Cardiology, University of Verona School of Medicine, University Hospital, Italy.
Drugs. 1999;57 Suppl 1:19-26. doi: 10.2165/00003495-199957001-00003.
The calcium antagonist lacidipine has been shown to be highly vasoselective and to improve myocardial perfusion in hypertensive patients. However, its effects on coronary artery vasomotility and on post-stenotic coronary flow reserve in patients with atherosclerotic heart disease are unknown.
This study was designed to investigate the acute direct effects of repeated infusions of lacidipine on epicardial coronary artery vasomotion and on post-stenotic coronary artery blood flow in patients with stable angina pectoris and angiographic evidence of coronary heart disease.
In 8 patients with stable angina and moderate to severe stenosis of the left coronary artery, measurements of epicardial dimensions (quantitative angiography) and of coronary blood flow (Doppler guidewire) distal to a stenosis were performed at baseline and after 3 repeated intracoronary boluses of 12 microg of lacidipine. Results were compared with those obtained after 10 mg of intracoronary papaverine.
The intracoronary administration of lacidipine was well tolerated, without any adverse effects. Lacidipine significantly increased the minimal luminal diameter of the lesion (peak relative increase of 43.7%), without significant changes in heart rate and systolic aortic pressure. Intracoronary lacidipine caused a dose-dependent increase in coronary flow reserve. Maximal vasodilatory effects were equivalent to those obtained with intracoronary papaverine.
These results suggest that lacidipine acts directly as a potent vasodilator in stenotic epicardial vessels and improves myocardial perfusion distal to a moderately severe stenosis in patients with stable angina.
钙拮抗剂拉西地平已被证明具有高度的血管选择性，并能改善高血压患者的心肌灌注。然而，其对动脉粥样硬化性心脏病患者冠状动脉血管舒缩功能及狭窄后冠状动脉血流储备的影响尚不清楚。
本研究旨在探讨重复输注拉西地平对稳定型心绞痛且有冠心病血管造影证据患者的心外膜冠状动脉血管运动及狭窄后冠状动脉血流的急性直接影响。
在8例患有稳定型心绞痛且左冠状动脉中度至重度狭窄的患者中，于基线时以及在冠状动脉内重复推注3次12微克拉西地平后，测量狭窄远端的心外膜尺寸（定量血管造影）和冠状动脉血流（多普勒导丝）。将结果与冠状动脉内注射10毫克罂粟碱后获得的结果进行比较。
冠状动脉内给予拉西地平耐受性良好，无任何不良反应。拉西地平显著增加病变的最小管腔直径（峰值相对增加43.7%），心率和主动脉收缩压无显著变化。冠状动脉内注射拉西地平使冠状动脉血流储备呈剂量依赖性增加。最大血管舒张作用与冠状动脉内注射罂粟碱所获得的作用相当。
这些结果表明，拉西地平在狭窄的心外膜血管中直接作为一种强效血管扩张剂起作用，并改善稳定型心绞痛患者中重度狭窄远端的心肌灌注。
