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[Differential therapy of myocardial ischemia in females]
E Neumann1, K H Günther, P Romaniuk
1Regierungskrankenhaus der DDR, Humboldt-Universität, Berlin, DDR.
Insights
This study investigated treatments for myocardial ischemia in women. Nifedipine and Dipyridamole showed promise for improving cardiac output in women with reduced perfusion but normal coronary arteries.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Context:
- Myocardial ischemia can occur without coronary artery stenoses, particularly in women.
- Peripheral perfusion abnormalities are a potential cause.
- Exercise electrocardiogram (ECG) and hemodynamic studies are crucial for diagnosis.
Purpose:
- To evaluate the hemodynamic effects of nitroglycerin, nifedipine, and dipyridamole in women with exercise-induced myocardial ischemia.
- To differentiate between ischemia due to coronary stenoses and that caused by perfusion abnormalities.
Summary:
- Eighty-five women with abnormal exercise ECGs underwent hemodynamic assessments. Group II (coronary stenoses) showed elevated left ventricular volumes and pulmonary artery pressure; nifedipine normalized these. Group III (reduced perfusion, no stenoses) had reduced cardiac output and elevated pulmonary artery pressure; nitroglycerin worsened cardiac output, while nifedipine and dipyridamole improved it.
- Nifedipine normalized hemodynamic parameters in women with coronary stenoses.
- Nifedipine and dipyridamole improved cardiac output in women with reduced perfusion without stenoses, suggesting efficacy in managing this specific type of ischemia.
Impact:
- Nifedipine and dipyridamole may be more effective long-term treatments than nitrates for women with reduced myocardial perfusion and normal coronary arteries.
- This research highlights the importance of assessing cardiac output and perfusion in women with ischemia.
- Findings guide therapeutic strategies for specific subgroups of women experiencing myocardial ischemia.
Abstract:
Peripheral perfusion abnormalities are considered a possible reason for myocardial ischemia in the absence of visible coronary artery stenoses. In 85 women (age: 41-58 years, mean age: 46 +/- 8) with pathological exercise ECG (precordial mapping: 50 leads), hemodynamic studies were performed without medication, after sublingual nitroglycerin (NTG, 0.8 mg), sublingual Nifedipin (N, 30 mg), and intravenous Dipyridamol (D, 0.5 mg/kg). Eighteen women showed normal coronary arteries and a normal myocardial perfusion (group I), 21 an impaired perfusion due to coronary stenoses (Group II), and 46 women a reduced perfusion without visible changes (Group III). Reference methods were measurement of pulmonary artery pressure, 201-TI-scintigraphy, and coronary angiography. In group II, enddiastolic and endsystolic left ventricular volume (EDV, ESV) as well as enddiastolic pulmonary artery pressure (pAd) were increased, the ejection fraction (EF) was reduced, and cardiac output (CO) was normal. In group III, ESV, EDV, EF, and CO were significantly reduced, while pAd increased. In group II, N led to a normalization of ESV, EDV, EF, and pAd. In group III, NTG led to a reduction of pAd and EDV, and concomitantly to a further reduction of the already low CO. In both groups the reduction of ST-segment depressions after NTG was significant. N led to a moderate reduction of pAd and ST-segment depression, but to an increase of CO in both groups. D exhibited a comparable effect in group III. In group II an increase of ST-segment changes and of pAd with unchanged CO was observed. With regard to longterm treatment of women in group III, N and D seemed to be more efficacious than nitrates due to a beneficial effect on cardiac output.