Esposito G, Piscione F, Giunta A, Indolfi C, Maione S, Arnese M R, Condorelli M, Chiariello M
Cattedra di Cardiologia, Facoltà di Medicina e Chirurgia, Università degli Studi Federico II, Napoli.
Cardiologia. 1993 Aug;38(8):503-11.
Eighteen patients with isolated stenosis of left anterior descending artery, were randomly given 0.2 mg of nifedipine (Group II) or its solvent (Group I) via balloon catheter positioned across the lesion immediately prior balloon occlusion. Peak velocity of early (E peak) and late (A peak) filling, velocity flow integral at early (E area) and late (A area) filling and their ratios (by echo-Doppler) and heart rate, mean aortic and wedge (W) pressures were measured at baseline, 15 and 30 s during balloon occlusion and 10 min after balloon deflation. In Group I we observed a significant decrease in either E peak at 15 and 30 s (-24.7%, -29.3% respectively) and E area (-32.8%, -40.0% respectively) with a non significant increase in both A peak and A area. Accordingly, either E/A peak ratio and E/A area ratio decreased significantly. In Group II no significant changes were observed in the echo-Doppler parameters of left ventricular filling. Wedge pressure also significantly increased in Group I at 15 and 30 s (68.7% and 97.9% respectively), while a significant increase in Group II occurred only at 30 s (32.5%). Heart rate significantly increased only in Group I at 15 and 30 s (10.3% and 11% respectively), while aortic pressure remained unchanged in both groups. Thus, nifedipine given intracoronary in the post-stenotic area just before balloon occlusion prevents left ventricular filling dynamic alteration by preserving early filling.
18例单纯左前降支狭窄患者，在球囊闭塞前，通过置于病变处的球囊导管随机给予0.2mg硝苯地平（II组）或其溶剂（I组）。在基线、球囊闭塞期间的15秒和30秒以及球囊放气后10分钟，测量早期（E峰）和晚期（A峰）充盈的峰值速度、早期（E面积）和晚期（A面积）充盈的速度血流积分及其比值（通过超声多普勒）以及心率、平均主动脉压和楔压（W）。在I组中，我们观察到在15秒和30秒时E峰（分别下降24.7%、29.3%）和E面积（分别下降32.8%、40.0%）显著降低，而A峰和A面积均有非显著性增加。相应地，E/A峰比值和E/A面积比值均显著降低。在II组中，左心室充盈的超声多普勒参数未观察到显著变化。I组在15秒和30秒时楔压也显著升高（分别为68.7%和97.9%），而II组仅在30秒时出现显著升高（32.5%）。仅I组在15秒和30秒时心率显著增加（分别为10.3%和11%），而两组主动脉压均保持不变。因此，在球囊闭塞前在狭窄后区域冠状动脉内给予硝苯地平可通过保留早期充盈来防止左心室充盈动力学改变。
