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[Direct myocardial anti-ischemic effect of diltiazem in the human]
Abstract:
In a randomized double blind placebo-controlled study in 20 patients the influence of the calcium antagonist diltiazem (1.0 mg administered intracoronarily, distal from the stenosis) on the severity of myocardial ischemia during therapeutic coronary occlusion (transluminal coronary angioplasty) of the left anterior descending coronary artery was investigated. The severity and time of onset of ischemic ST and T wave changes as well as anginal pain were significantly reduced 3 and 8 minutes after diltiazem, whereas there was no definite change in the controls. Heart rate and blood pressure were not influenced by diltiazem or placebo. The results indicate a direct antiischemic effect of diltiazem on myocardial cells. The findings can neither be explained by an influence on cardiac afterload nor by coronary vessel reactions, nor a reduction of myocardial contractility. The findings do not permit conclusions in terms of the duration of this direct antiischemic mode of action.
Insights
Diltiazem, a calcium antagonist, significantly reduced myocardial ischemia and anginal pain during coronary angioplasty. This study suggests a direct anti-ischemic effect of diltiazem on heart cells, independent of blood pressure or heart rate changes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Myocardial ischemia is a critical condition often managed during procedures like coronary angioplasty.
- Calcium antagonists are explored for their potential to mitigate ischemic events.
Purpose of the Study:
- To investigate the direct anti-ischemic effect of intracoronary diltiazem during therapeutic coronary occlusion.
- To assess the impact of diltiazem on ST-T wave changes and anginal pain during angioplasty.
Main Methods:
- A randomized, double-blind, placebo-controlled study involving 20 patients undergoing left anterior descending coronary artery angioplasty.
- Diltiazem (1.0 mg) or placebo was administered intracoronarily, distal to the stenosis.
- Evaluation of ischemic ST-T wave changes and anginal pain at 3 and 8 minutes post-administration.
Main Results:
- Diltiazem significantly reduced the severity and delayed the onset of ischemic ST-T wave changes.
- Anginal pain was also significantly reduced following diltiazem administration.
- No significant changes in heart rate or blood pressure were observed with diltiazem or placebo.
Conclusions:
- Intracoronary diltiazem exhibits a direct anti-ischemic effect on myocardial cells during coronary angioplasty.
- This effect is not attributable to changes in cardiac afterload, coronary vasoreactivity, or myocardial contractility.
- The study highlights a direct cellular mechanism for diltiazem's anti-ischemic properties, though duration requires further investigation.