Mahmarian J J, Fenimore N L, Marks G F, Francis M J, Morales-Ballejo H, Verani M S, Pratt C M
Department of Medicine, Baylor College of Medicine, Houston, Texas.
J Am Coll Cardiol. 1994 Jul;24(1):25-32. doi: 10.1016/0735-1097(94)90537-1.
This study prospectively evaluated whether transdermal nitroglycerin patches could limit the extent of exercise-induced left ventricular ischemia as assessed by quantitative thallium-201 tomography.
Although antianginal medications are effective at reducing chest pain symptoms in patients with coronary artery disease, there is limited evidence that these agents can also reduce myocardial ischemia.
This was a randomized, double-blind, parallel, placebo-controlled trial evaluating nitroglycerin patch therapy in patients in stable condition with angiographic coronary artery disease and no previous myocardial infarction. All patients were weaned from antianginal agents and had a baseline symptom-limited treadmill test followed by thallium-201 tomography. Forty patients with perfusion defects involving > or = 5% of the left ventricle were randomized to receive either intermittent (12 h on/off) active nitroglycerin patch therapy (0.4 mg/h) or placebo. Exercise tomography was repeated a mean (+/- SD) of 6.1 +/- 1.8 days after randomization.
Patients randomized to receive active patch therapy had a significant reduction in their total perfusion defect size (-8.9 +/- 11.1%) compared with placebo-treated patients (-1.8 +/- 6.1%, p = 0.04), which was most apparent in those with the largest (> or = 20%) baseline perfusion defects (-11.4 +/- 13.4% vs. 1.0 +/- 3.6%, respectively, p < 0.02). Furthermore, 7 (33%) of 21 patients receiving active therapy had a > or = 10% decrease in their perfusion defects compared with only 1 (5%) of 19 patients randomized to receive placebo (p = 0.002). Nitrate therapy did not significantly reduce heart rate, blood pressure or double product, indicating benefit through enhancement of coronary blood flow.
Short-term, intermittent nitroglycerin patch therapy significantly reduces myocardial ischemia, particularly in patients with large ischemic perfusion defects. Thallium-201 tomography can be used to assess sequential changes in the extent of exercise-induced left ventricular ischemia.
本研究通过定量铊-201断层扫描前瞻性评估经皮硝酸甘油贴片是否能限制运动诱发的左心室缺血范围。
尽管抗心绞痛药物能有效减轻冠心病患者的胸痛症状，但这些药物能否减轻心肌缺血的证据有限。
这是一项随机、双盲、平行、安慰剂对照试验，评估硝酸甘油贴片疗法对病情稳定、有冠状动脉造影证据且既往无心肌梗死的患者的疗效。所有患者停用抗心绞痛药物，进行症状限制的基线跑步机试验，随后进行铊-201断层扫描。40例左心室灌注缺损累及≥5%的患者被随机分为接受间歇性（12小时开/关）活性硝酸甘油贴片疗法（0.4毫克/小时）或安慰剂。随机分组后平均（±标准差）6.1±1.8天重复运动断层扫描。
与接受安慰剂治疗的患者（-1.8±6.1%，p = 0.04）相比，随机接受活性贴片疗法的患者总灌注缺损大小显著降低（-8.9±ll.l%），这在基线灌注缺损最大（≥20%）的患者中最为明显（分别为-11.4±13.4%和1.0±3.6%，p < 0.02）。此外，接受活性治疗的21例患者中有7例（33%）灌注缺损减少≥10%，而随机接受安慰剂的19例患者中只有1例（5%）出现这种情况（p = 0.002）。硝酸盐疗法未显著降低心率、血压或双乘积，表明其益处在于增加冠状动脉血流量。
短期、间歇性硝酸甘油贴片疗法能显著减轻心肌缺血，尤其是在有大面积缺血性灌注缺损的患者中。铊-201断层扫描可用于评估运动诱发的左心室缺血范围的连续变化。
