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  • Title: Diltiazem alone and combined with nitroglycerin: effect on normal and diseased human coronary arteries.
    Author: Hess OM, Nonogi H, Bortone A, Gage JE, Grimm J, Krayenbuehl HP.
    Journal: Eur Heart J; 1989 Nov; 10 Suppl F():142-6. PubMed ID: 2515968.
    Abstract:
    The vasodilatory effect of diltiazem and nitroglycerin on the large epicardial coronary arteries was evaluated in 26 patients with coronary artery disease. The luminal area of a normal and a stenotic coronary artery was determined at rest, after intracoronary administration of diltiazem, during submaximal exercise as well as 5 min after 1.6 mg sublingual nitroglycerin using biplane quantitative coronary arteriography. Twelve patients with no pretreatment prior to the exercise test served as group 1 (controls) and 14 patients with intracoronary administration of 2 to 3 mg diltiazem prior to the exercise test as group 2. Normal vessel: In the control group luminal area increased significantly during exercise (+23%, P less than 0.01) and after sublingual administration of nitroglycerin (+40%, P less than 0.001). In group 2 luminal area increased after intracoronary administration of diltiazem (+19%, P less than 0.01), during bicycle exercise (+23%, P less than 0.001) and after sublingual administration of nitroglycerin (+39%, P less than 0.001). Stenotic vessel: In the control group luminal area decreased significantly (-29%, P less than 0.001) during bicycle exercise but increased after sublingual administration of nitroglycerin at the end of the exercise test (+12%, NS vs. rest). In group 2 intracoronary administration of diltiazem was associated with a mild increase in stenosis area (+11%, P less than 0.05). There was a further increase in stenosis area during bicycle exercise (+23%, P less than 0.001 vs. rest) and after sublingual nitroglycerin (+32%, P less than 0.001). Coronary vasodilation of the stenotic segment was, however, significantly more pronounced after sublingual nitroglycerin in group 2 than 1 (+32% versus 12%, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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