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European Heart Journal 1989 10(Supplement F):142-146; doi:10.1093/eurheartj/10.suppl_F.142
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Diltiazem alone and combined with nitroglycerin: effect on normal and diseased human coronary arteries

O. M. Hess, H. Nonogi, A. Bortone, J. E. Gage, J. Grimm and H. P. Krayenbuehl

Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital Zurich, Switzerland

Address for correspondence: Otto M. Hess, M.D., Medical Policlinic, Cardiology, University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland

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<0·01) and after sublingual administration of nitroglycerin (+40%, P<0·001). In group 2 luminal area increased after intracoronary administration of diltiazem (+19%, P<0·01), during bicycle exercise (+23%, P<0·001) and after sublingual administration of nitroglycerin (+39%, P<0·001).

Stenotic vessel: In the control group luminal area decreased significantly (–29%, P<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<0·05). There was a further increase in stenosis area during bicycle exercise (+23%, P<0·001 vs. rest) and after sublingual nitroglycerin (+32%, P<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<0·05).

Thus, it is concluded that diltiazem prevents exercise-induced coronary vasoconstriction of the stenotic vessel segment probably due to its direct vasorelaxing action on the smooth vasculature. Diltiazem combined with nitroglycerin elicits an additive effect on coronary vasodilation of the stenotic vessel segments but not on the normal coronary arteries. The exact mechanism of this additive effect is not clear but might be due to the combined action of the two vasoactive drugs with different mode of action.

Key Words: Coronary vasomotion • quantitative coronary arteriography • coronary artery disease • intracoronary diltiazem • nitroglycerin


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