Abstract
Epicardial coronary artery diameter (ECAD), coronary blood flow velocity (CBFV), and coronary flow velocity reserve (CFVR) were analyzed at baseline and after a 500 μg i.e. bolus of diltiazem in nonstenotic coronary arteries of awake humans. Furthermore, patients (n = 25) were first randomized to pretreatment either with placebo (n = 12) or isosorbide dinitrate (0.5 μg/kg/min infusion) (n = 13). Diltiazem resulted in a significant increase in epicardial diameter (+ 10%; p = 0.001) and in coronary blood How (CBF) (+ 30%; p = 0.0001). Whereas basal CBFV only slightly increased (+7% NS), there was a significant fall in CFVR (− 11%; p = 0.001). The increase in coronary diameter and CBF after administration of i.e. diltiazem was comparable in placebo- and nitrate-pretreated patients. The decrease in CFVR, however, was restricted to the placebo-pretreated patients (−21%; p = 0.0004). Apparently, diltiazem attenuated the CFVR but only in the absence of nitrates. Thus, diltiazem i.e. appears to enhance myocardial oxygen supply without deleterious effects on the distal coronary perfusion pressure.
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