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Coronary artery dilation and hemodynamic responses after isosorbide dinitrate therapy in patients with coronary
Insights
Sublingual isosorbide dinitrate (ISDN) significantly dilates coronary arteries, improving blood flow in patients with coronary artery disease. This study shows ISDN effectively reduces stenosis resistance and improves hemodynamic function.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
- Vasodilators are crucial in managing CAD symptoms and improving cardiac function.
- The specific effects of sublingual isosorbide dinitrate (ISDN) on coronary artery dilation and hemodynamics in patients with suspected CAD require detailed investigation.
Purpose of the Study:
- To evaluate the hemodynamic and angiographic responses to sublingual isosorbide dinitrate (ISDN) in men with suspected coronary artery disease.
- To quantify the degree of coronary artery dilation in both normal and diseased segments following ISDN administration.
- To assess the impact of ISDN on pulmonary and systemic vascular resistance and cardiac output.
Main Methods:
- 10 men with suspected CAD underwent coronary arteriography and Swan-Ganz catheterization.
- Sublingual isosorbide dinitrate (ISDN) (5 or 10 mg) was administered.
- Hemodynamic parameters and sequential coronary angiograms were recorded for 30 minutes post-administration.
- Quantitative arteriography was used to measure luminal cross-sectional area and stenosis severity.
Main Results:
- Sublingual isosorbide dinitrate (ISDN) caused significant reductions in pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance, cardiac output, and mean arterial pressure.
- Quantitative coronary arteriography revealed substantial dilation in both normal and diseased coronary segments.
- Diseased segments showed a 51% increase in luminal area, and calculated stenosis resistance decreased by 40%.
- Smaller diseased arteries (<8 mm²) exhibited greater dilation (77%) compared to larger arteries (>8 mm²) (21%).
Conclusions:
- Sublingual isosorbide dinitrate (ISDN) is a potent vasodilator that effectively dilates both normal and diseased coronary arteries.
- ISDN improves hemodynamic parameters and reduces stenosis resistance in patients with coronary artery disease.
- The drug's efficacy is more pronounced in smaller diseased coronary arteries, suggesting a potential therapeutic benefit in specific patient subgroups.
Abstract:
The response to sublingual isosorbide dinitrate (ISDN) was studied in 10 men with suspected coronary artery disease undergoing coronary arteriography. A Swan-Ganz catheter was placed in the pulmonary artery to record hemodynamic response. Diseased coronary segments were identified during routine Judkins selective coronary angiograms. Sublingual isosorbide dinitrate (ISDN) (5 or 10 mg) was then given with the catheters in place. Multiple sequential single-view coronary angiograms and pulmonary and systemic hemodynamic responses were recorded over 30 minutes after drug administration. At 30 minutes, there was a 53% reduction (p less than 0.01) in pulmonary capillary wedge pressure and a 15% decrease (p less than 0.05) in systemic and pulmonary vascular resistance, with a net 13% decrease (p less than 0.01) in cardiac output and 20% decrease (p less than 0.01) in mean arterial pressure. Quantitative arteriography demonstrated substantial dilation of luminal cross-sectional area in both normal and diseased coronary arterial segments. Normal epicardial segments were grouped according to luminal area (1 to 4, 4 to 8 and more than 8 mm2) and demonstrated maximal area dilation at 10 minutes of 55% (p less than 0.01), 29% (p less than 0.01) and 16% (p less than 0.05), respectively. Diseased epicardial segments (stenosis 50% or greater) dilated 51% (p less than 0.01) at 10 minutes. Calculated stenosis resistance decreased 40% (p less than 0.01). Diseased segments in small and middle-sized arteries (1 to 8 mm2) are 4 times more reactive than those in larger arteries (more than 8 mm2), with peak dilation of 77 vs 21% (p less than 0.01) at 30 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)