Abstract
ObjectiveThe aim of this study is to observe the chronic effects of diltiazem release capsules on patients with coronary slow flow (CSF) phenomenon.MethodsFrom 2004 to 2009, 80 consecutive patients with chest pain and normal coronary arteries evidenced by coronary angiography and CSF were included in this randomized, double-blind, placebo-controlled trial. CSF patterns were evaluated by the corrected TIMI frame count. Patients were randomly assigned at 1∶1 ratio to diltiazem sustained-release capsules treatment group (Dil, 90 mg twice daily) or placebo control group. Holter, liver and kidney function, treadmill exercise test, coronary angiography and left ventricular angiography were measured at baseline and after 6 months. The incidence of cardiovascular events (re-admission or progress in coronary heart disease, myocardial infarction, malignant arrhythmia or cardiac death) was evaluated during the 6 months follow up.ResultsThirty-nine patients in control and 40 patients in Dil group completed the 6 months follow-up. There was no medication induced drug withdraw during follow up. Left ventricular ejection fraction was similar between the 2 groups at baseline and during follow up. Heart rate was significantly lower in Dil group than in control group and there was no symptomatic bradycardia and II and III degree atrioventricular conduction block in both groups. Significant improvement was observed in the onset of chest pain, treadmill exercise test and coronary blood flow in Dil group while these parameters remained unchanged in control group at the end of 6 months follow up. The incidence of cardiovascular events was similar between the two groups.ConclusionDiltiazem slow-release capsules improved coronary blood flow and alleviated angina in patients with CSF.Trial RegistrationChinese Clinical Trial Registry ChiCTR-TCC-11001864
Highlights
In 1972, Tambe [1] first reported coronary slow flow (CSF) phenomenon defining chest pain patients without significant coronary artery lesion but with slowed down coronary blood flow during coronary angiography examination
Serum creatinine and alanine transaminase remained unchanged during follow up in all patients while average 24 hours heart rate was significantly lower in Dil group than in control group during follow up (Table 2), there was no symptomatic bradycardia, II and III degree AVB at baseline and during follow up
CTFC was improved between baseline and at the end of follow up in both groups and the improvement was more significant in Dil group than in control group
Summary
In 1972, Tambe [1] first reported coronary slow flow (CSF) phenomenon defining chest pain patients without significant coronary artery lesion but with slowed down coronary blood flow during coronary angiography examination. Previous studies have shown that calcium antagonists could relief microvascular spasm [7,8] and intravascular application of diltiazem could to attenuate coronary artery spasm in patients with microvascular angina [9,10]. Effects of chronic oral calcium antagonists on CSF patients remain largely unknown now. This study aimed to observe the chronic effects of oral diltiazem sustained-release capsules in patients with CSF phenomenon. Data of chest pain frequency, 24-hour Holter, treadmill exercise test, coronary angiography and left ventricular angiography at baseline and at the end of 6 months follow up were compared between CSF patients receiving oral diltiazem sustained-release capsules or placebo. Major adverse cardiac events (re-hospitalization; acute coronary syndrome, malignant arrhythmia or cardiac death) during follow-up were recorded and liver and kidney functions were monitored during the study period
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