米贝拉地尔对冠状动脉慢血流现象的血管造影及临床益处。

The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon.

作者信息

Beltrame John F, Turner Stuart P, Leslie Sue L, Solomon Patty, Freedman Saul B, Horowitz John D

机构信息

Cardiology Unit, North Western Adelaide Health Service, University of Adelaide, Adelaide, Australia.

出版信息

J Am Coll Cardiol. 2004 Jul 7;44(1):57-62. doi: 10.1016/j.jacc.2004.03.055.

DOI:10.1016/j.jacc.2004.03.055

PMID:15234407

Abstract

OBJECTIVES

The aim of the study was to assess the angiographic and clinical benefits of the calcium T-channel blocker, mibefradil, in the coronary slow flow phenomenon (CSFP).

BACKGROUND

The CSFP is characterized by delayed vessel opacification on angiography (Thrombolysis In Myocardial Infarction [TIMI]-2 flow) in the absence of obstructive epicardial coronary disease and is often associated with recurrent chest pain.

METHODS

A total of 10 CSFP patients (46 +/- 9 years) underwent angiography before and 30 min after 50 mg mibefradil; off-line blinded analysis of angiographic data included comparisons of epicardial vessel diameter, TIMI flow grade and TIMI frame count. We also performed a randomized, double-blind, placebo-controlled, cross-over study to examine the long-term efficacy of mibefradil 100 mg/day on the frequency of total angina, prolonged angina (i.e., persisting >20 min) episodes, and sublingual nitrate consumption, during consecutive one-month treatment periods in 20 patients (age 51 +/- 12 years) with the CSFP.

RESULTS

Without changing epicardial vessel diameter or rate-pressure product, mibefradil reduced the number of vessels exhibiting TIMI-2 flow from 18 to 5; furthermore, mibefradil significantly improved the TIMI frame count only in those vessels exhibiting TIMI-2 flow (28 +/- 18%, p < 0.005). Compared with placebo, mibefradil significantly reduced total angina frequency by 56% (p < 0.001), prolonged episodes of angina by 74% (p < 0.001), and sublingual nitrate consumption by 59% (p < 0.01); furthermore, mibefradil improved physical quality of life as assessed by the Health Outcome Study Short Form-36.

CONCLUSIONS

These angiographic and clinical improvements produced by mibefradil support a microspastic pathogenesis of the CSFP.

摘要

目的

本研究旨在评估钙T通道阻滞剂米贝拉地尔对冠状动脉慢血流现象（CSFP）的血管造影和临床益处。

背景

CSFP的特征是在无阻塞性心外膜冠状动脉疾病的情况下，血管造影时血管显影延迟（心肌梗死溶栓治疗[TIMI]-2级血流），且常与复发性胸痛相关。

方法

总共10例CSFP患者（46±9岁）在服用50毫克米贝拉地尔之前和之后30分钟接受血管造影；血管造影数据的离线盲法分析包括心外膜血管直径、TIMI血流分级和TIMI帧数的比较。我们还进行了一项随机、双盲、安慰剂对照、交叉研究，以检查100毫克/天米贝拉地尔对20例（年龄51±12岁）CSFP患者在连续一个月治疗期间总心绞痛频率、延长型心绞痛（即持续>20分钟）发作次数和舌下硝酸酯类药物消耗量的长期疗效。

结果

在不改变心外膜血管直径或心率-血压乘积的情况下，米贝拉地尔使表现为TIMI-2级血流的血管数量从18条减少至5条；此外，米贝拉地尔仅在表现为TIMI-2级血流的血管中显著改善了TIMI帧数（28±18%，p<0.005）。与安慰剂相比，米贝拉地尔使总心绞痛频率显著降低56%（p<0.001），延长型心绞痛发作次数减少74%（p<0.001），舌下硝酸酯类药物消耗量减少59%（p<0.01）；此外，根据健康结局研究简表-36评估，米贝拉地尔改善了身体生活质量。