Vrolix M C, Sionis D, Piessens J H, Van Lierde J, Willems J L, De Geest H
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Am J Cardiol. 1991 Dec 15;68(17):1633-7. doi: 10.1016/0002-9149(91)90321-b.
To analyze the effect of the calcium antagonist diltiazem on coronary hemodynamics, epicardial coronary artery diameter, coronary blood flow and coronary blood flow velocity were assessed at baseline and after a 0.5 mg intracoronary bolus of diltiazem in nonstenotic coronary arteries of awake humans. Patients (n = 20) were first randomized to pretreatment with either placebo (n = 10) or isosorbide dinitrate (0.5 microgram/kg/min infusion; n = 10), and coronary flow reserve was measured before and after administration of diltiazem. There were significant increases in epicardial coronary artery diameter (10%; p = 0.0001) and coronary blood flow (30%; p = 0.0001) in all patients after administration of diltiazem. Whereas basal coronary blood flow velocity increased only slightly (7%; p = not significant), there was a significant decrease in coronary flow reserve (10%; p = 0.004). Increases in coronary diameter and blood flow after diltiazem were comparable in patients pretreated with placebo or nitrates. However, the decrease in coronary flow reserve was significant only in patients pretreated with placebo (19%; p = 0.0008). This reduction in coronary flow reserve could be due to "raising the floor" (increased baseline coronary blood flow) or "lowering the ceiling" (reduction of maximal coronary blood flow).
为分析钙拮抗剂地尔硫䓬对冠状动脉血流动力学的影响，在清醒人体的非狭窄冠状动脉中，于基线状态及冠脉内注射0.5mg地尔硫䓬后，评估心外膜冠状动脉直径、冠状动脉血流量及冠状动脉血流速度。患者（n = 20）首先随机分为接受安慰剂预处理组（n = 10）或硝酸异山梨酯预处理组（0.5微克/千克/分钟输注；n = 10），并在给予地尔硫䓬前后测量冠状动脉血流储备。给予地尔硫䓬后，所有患者的心外膜冠状动脉直径（增加10%；p = 0.0001）和冠状动脉血流量（增加30%；p = 0.0001）均显著增加。虽然基础冠状动脉血流速度仅略有增加（7%；p = 无显著性差异），但冠状动脉血流储备显著降低（10%；p = 0.004）。地尔硫䓬给药后冠状动脉直径和血流量的增加在接受安慰剂或硝酸盐预处理的患者中相当。然而，冠状动脉血流储备的降低仅在接受安慰剂预处理的患者中显著（19%；p = 0.0008）。冠状动脉血流储备的这种降低可能是由于“提高下限”（增加基线冠状动脉血流量）或“降低上限”（降低最大冠状动脉血流量）。
