title: Diltiazem alone and combined with nitroglycerin: effect on normal and diseased human coronary arteries.
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)
authors.affiliation: Department of Internal Medicine, University Hospital, Zurich, Switzerland.
authors.forename: O M
authors.initials: OM
authors.lastname: Hess
authors.forename: H
authors.initials: H
authors.lastname: Nonogi
authors.forename: A
authors.initials: A
authors.lastname: Bortone
authors.forename: J E
authors.initials: JE
authors.lastname: Gage
authors.forename: J
authors.initials: J
authors.lastname: Grimm
authors.forename: H P
authors.initials: HP
authors.lastname: Krayenbuehl
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects*; D004110:Diltiazem / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005080:Exercise Test; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007269:Injections, Intra-Arterial; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D014664:Vasodilation / Q000187:drug effects*
chemical_list: D004110:Diltiazem; D005996:Nitroglycerin