Effect of Diltiazem on Coronary Artery Flow and Myocardial Perfusion in Patients With Isolated Coronary Artery Ectasia and Either Stable Angina Pectoris or Positive Myocardial Ischemic Stress Test.
Isolated coronary artery ectasia (CAE) may be associated with stable or unstable coronary events despite the absence of epicardial coronary stenosis. Impaired coronary flow dynamics and myocardial perfusion have been demonstrated in stable patients with ectatic coronary arteries. We aimed to assess whether epicardial flow and tissue-level perfusion would be improved by diltiazem in myocardial regions subtended by the ectatic coronary arteries in patients with isolated CAE. A total of 60 patients with isolated CAE were identified of 9,780 patients who underwent elective coronary angiography. Patients were randomized to 5 mg of intracoronary diltiazem or saline. Coronary blood flow of the microvascular network was assessed using myocardial blush grade (MBG) technique. The thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (TFC) were used to assess epicardial coronary flow. MBG (from 2.4 to 2.6, p = 0.02), TIMI flow grades (from 2.4 to 2.8, p <0.001), and TFC (from 35 to 26, p <0.001) were significantly improved after diltiazem, whereas no significant change was noticed after saline (from 2.4 to 2.4, p = 0.86 for MBG; from 2.3 to 2.3, p = 0.71 for TIMI flow grade; and from 35 to 33, p = 0.43 for TFC). Diltiazem provided amelioration of the altered coronary flow dynamics, which was suggested as the pathophysiological influence of CAE. In conclusion, the favorable effects of the diltiazem on myocardial perfusion were observed at both epicardial and tissue levels.
Department of Cardiology, Ankara University, Ankara, Turkey. Electronic address: ozgurulasozcan@yahoo.com.tr.
Ozgur Ulas
OU
Ozcan
Department of Cardiology, Ankara University, Ankara, Turkey.
Yusuf
Y
Atmaca
Department of Cardiology, Ankara University, Ankara, Turkey.
Huseyin
H
Goksuluk
Department of Cardiology, Ankara University, Ankara, Turkey.
Irem Muge
IM
Akbulut
Department of Cardiology, Ankara University, Ankara, Turkey.
Nil
N
Ozyuncu
Department of Cardiology, Ankara University, Ankara, Turkey.
Nedret
N
Ersoy
Department of Cardiology, Ankara University, Ankara, Turkey.
Cetin
C
Erol
D000368:Aged; D060050:Angina, Stable / Q000188:drug therapy* / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D003326:Coronary Circulation / Q000187:drug effects*; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000503:physiopathology; D004110:Diltiazem / Q000627:therapeutic use*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D010496:Pericardium; D011446:Prospective Studies; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D004110:Diltiazem