Berkenboom G M, Unger P, Jottrand M, Loiseau J, Pype F, Degre S G
Département de Cardiologie, Université Libre de Bruxelles, Hôpital Erasme, Belgique.
Cardiology. 1987;74(6):427-35. doi: 10.1159/000174235.
To investigate the mechanism of action of nitrovasodilators in exercise-induced angina, 15 patients with chronic stable angina underwent a symptom-limited supine exercise test (exercise 1). After recovery, in 10 patients (group I) a coronary vasodilator, SIN-1 (the active metabolite of molsidomine) was injected into the most diseased coronary artery (80 micrograms in 4 min). In the remaining 5, a placebo was injected (group II). Immediately thereafter, the same exercise (exercise 2, identical workloads and exercise duration) was repeated. In group I, after intracoronary injection of SIN-1, the control values at rest (including pulmonary wedge pressure) did not significantly change. Heart rate, blood pressure and cardiac index rose in a similar way during exercises 1 and 2 (61, 20, 26 and 62, 21, 35%, respectively). However, 3 patients were angina-free without ST-changes during exercise 2. In the remaining 7, the ST/heart rate slope was reduced (60%; p less than 0.02), the increase in pulmonary wedge pressure was less pronounced (p less than 0.01) and ST-depression at end-exercise 2 was smaller: 1.3 +/- 0.3 versus 2.1 +/- 0.3 mm (p less than 0.01) for identical work loads and double products. In group II, exercise 2 was identical to exercise 1 and the ST/heart rate slopes were quite reproducible. Therefore, these results argue for an improvement in coronary blood supply after intracoronary SIN-1 and suggest that the beneficial action of nitrovasodilators could be related to direct effects on the coronary circulation. However, the magnitude of this mechanism seems variable from one patient to another.
为研究硝基血管扩张剂在运动诱发型心绞痛中的作用机制，15例慢性稳定型心绞痛患者接受了症状限制型仰卧运动试验（运动1）。恢复后，10例患者（I组）向病变最严重的冠状动脉内注射冠状动脉血管扩张剂SIN-1（吗多明的活性代谢产物，4分钟内注射80微克）。其余5例患者注射安慰剂（II组）。此后立即重复相同的运动（运动2，相同的工作量和运动持续时间）。在I组中，冠状动脉内注射SIN-1后，静息时的对照值（包括肺楔压）无明显变化。运动1和运动2期间心率、血压和心脏指数以相似的方式升高（分别为61%、20%、26%和62%、21%、35%）。然而，3例患者在运动2期间无心绞痛且无ST段改变。其余7例患者中，ST/心率斜率降低（60%；p<0.02），肺楔压升高不明显（p<0.01），运动2结束时的ST段压低较小：相同工作量和双倍乘积时分别为1.3±0.3毫米和2.1±0.3毫米（p<0.01）。在II组中，运动2与运动1相同，ST/心率斜率具有良好的可重复性。因此，这些结果表明冠状动脉内注射SIN-1后冠状动脉供血得到改善，提示硝基血管扩张剂的有益作用可能与对冠状动脉循环的直接作用有关。然而，这种机制的程度在不同患者之间似乎存在差异。
