Vrolix M C, Sionis D, Piessens J, Van Lierde J, Willems J L, De Geest H
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
J Cardiovasc Pharmacol. 1991;18 Suppl 9:S64-7.
Epicardial coronary artery diameter (ECAD), coronary blood flow velocity (CBFV), and coronary flow velocity reserve (CFVR) were analyzed at baseline and after a 500 micrograms i.c. bolus of diltiazem in nonstenotic coronary arteries of awake humans. Furthermore, patients (n = 25) were first randomized to pretreatment either with placebo (n = 12) or isosorbide dinitrate (0.5 micrograms/kg/min infusion) (n = 13). Diltiazem resulted in a significant increase in epicardial diameter (+10%; p = 0.001) and in coronary blood flow (CBF) (+30%; p = 0.0001). Whereas basal CBFV only slightly increased (+7%; NS), there was a significant fall in CFVR (-11%; p = 0.001). The increase in coronary diameter and CBF after administration of i.c. diltiazem was comparable in placebo- and nitrate-pretreated patients. The decrease in CFVR, however, was restricted to the placebo-pretreated patients (-21%; p = 0.0004). Apparently, diltiazem attenuated the CFVR but only in the absence of nitrates. Thus, diltiazem i.c. appears to enhance myocardial oxygen supply without deleterious effects on the distal coronary perfusion pressure.
在清醒人类的非狭窄冠状动脉中，于基线期及给予500微克地尔硫䓬心内注射推注后，分析了心外膜冠状动脉直径（ECAD）、冠状动脉血流速度（CBFV）和冠状动脉血流储备（CFVR）。此外，患者（n = 25）首先被随机分为接受安慰剂预处理（n = 12）或硝酸异山梨酯（0.5微克/千克/分钟输注）预处理（n = 13）。地尔硫䓬导致心外膜直径显著增加（+10%；p = 0.001）以及冠状动脉血流（CBF）显著增加（+30%；p = 0.0001）。虽然基础CBFV仅略有增加（+7%；无统计学意义），但CFVR显著下降（-11%；p = 0.001）。给予心内地尔硫䓬后冠状动脉直径和CBF的增加在接受安慰剂预处理和硝酸盐预处理的患者中相当。然而，CFVR的下降仅限于接受安慰剂预处理的患者（-21%；p = 0.0004）。显然，地尔硫䓬减弱了CFVR，但仅在无硝酸盐的情况下。因此，心内地尔硫䓬似乎可增加心肌氧供应，而对远端冠状动脉灌注压无有害影响。
