Antunes E, Serra J, Ferreira R, Catarino C, da Silva N, de Oliveira M, Quininha J, Prates A S, Gracias R, Rato J A
Department of Cardiology, Santa Marta Hospital, Lisbon.
Rev Port Cardiol. 1993 Mar;12(3):219-23.
To evaluate the effect of diltiazem on the characteristics of ischemic episodes detected by Holter monitoring in a group of patients with proven coronary artery disease.
Department of Cardiology, Santa Marta Hospital, Lisbon.
Eleven selected out-patients, aged 48 to 79 years, with transient ST-segmental depression on Holter monitoring and proven coronary artery disease, were submitted to a double-blind crossover placebo controlled study, during hospitalization. The total ischemic burden of each patient and an analysis of ischemic episodes were evaluated before and during the drug/placebo phase trial. Three groups of ischemic episodes were considered: group I constituted by 66 episodes found on basal Holter recording; group II by 28 episodes detected during placebo trial and group III by 12 episodes detected during diltiazem trial.
A reduction of the number of ischemic episodes was predominantly observed with the diltiazem administration. Statistically significant differences were observed between basal and placebo groups and especially between basal and diltiazem groups concerning the mean maximum ST-segment depression (2.17 vs 1.80; p = 0.030 and 2.17 vs 1.54; p = 0.0091). Significant differences were also obtained between the above mentioned groups concerning the heart rate variation from the onset of ST-segment depression to its maximum depression (13.5 vs 9.69; p = 0.023 and 13.5 vs 2.91; p = 0.01) and from two minutes before the onset of ST-segment depression to its maximum depression (21.2 vs 12.67; p = 0.012 and 21.2 vs 8.75 p = 0.016).
Diltiazem seems to reduce the number of ischemic episodes in patients with coronary artery disease, during hospitalization. The study of its effects on the characteristics of ischemia requires further investigation with a greater number of patients. The limitations of the present study, described in the discussion, must be taken into account in future pharmacological investigations with Holter monitoring.
评估地尔硫䓬对一组经证实患有冠状动脉疾病患者动态心电图监测发现的缺血发作特征的影响。
里斯本圣玛尔塔医院心脏病科。
11名年龄在48至79岁之间、动态心电图监测有短暂ST段压低且经证实患有冠状动脉疾病的门诊患者，在住院期间接受了一项双盲交叉安慰剂对照研究。在药物/安慰剂阶段试验之前和期间，评估了每位患者的总缺血负荷并分析了缺血发作情况。缺血发作分为三组：第一组由基础动态心电图记录中发现的66次发作组成；第二组由安慰剂试验期间检测到的28次发作组成；第三组由地尔硫䓬试验期间检测到的12次发作组成。
地尔硫䓬给药后主要观察到缺血发作次数减少。在基础组与安慰剂组之间，特别是基础组与地尔硫䓬组之间，观察到平均最大ST段压低存在统计学显著差异（2.17对1.80；p = 0.030以及2.17对1.54；p = 0.0091）。在上述组之间，从ST段压低开始到最大压低时的心率变化（13.5对9.69；p = 0.023以及13.5对2.91；p = 0.01）以及从ST段压低开始前两分钟到最大压低时的心率变化（21.2对12.67；p = 0.012以及21.2对8.75；p = 0.016）也存在显著差异。
地尔硫䓬似乎可减少住院期间冠状动脉疾病患者的缺血发作次数。关于其对缺血特征影响的研究需要更多患者进行进一步调查。在未来使用动态心电图监测的药理学研究中，必须考虑本研究讨论中描述的局限性。
