Document Detail


The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon.
MedLine Citation:
PMID:  15234407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of the study was to assess the angiographic and clinical benefits of the calcium T-channel blocker, mibefradil, in the coronary slow flow phenomenon (CSFP). BACKGROUND: The CSFP is characterized by delayed vessel opacification on angiography (Thrombolysis In Myocardial Infarction [TIMI]-2 flow) in the absence of obstructive epicardial coronary disease and is often associated with recurrent chest pain. METHODS: A total of 10 CSFP patients (46 +/- 9 years) underwent angiography before and 30 min after 50 mg mibefradil; off-line blinded analysis of angiographic data included comparisons of epicardial vessel diameter, TIMI flow grade and TIMI frame count. We also performed a randomized, double-blind, placebo-controlled, cross-over study to examine the long-term efficacy of mibefradil 100 mg/day on the frequency of total angina, prolonged angina (i.e., persisting >20 min) episodes, and sublingual nitrate consumption, during consecutive one-month treatment periods in 20 patients (age 51 +/- 12 years) with the CSFP. RESULTS: Without changing epicardial vessel diameter or rate-pressure product, mibefradil reduced the number of vessels exhibiting TIMI-2 flow from 18 to 5; furthermore, mibefradil significantly improved the TIMI frame count only in those vessels exhibiting TIMI-2 flow (28 +/- 18%, p < 0.005). Compared with placebo, mibefradil significantly reduced total angina frequency by 56% (p < 0.001), prolonged episodes of angina by 74% (p < 0.001), and sublingual nitrate consumption by 59% (p < 0.01); furthermore, mibefradil improved physical quality of life as assessed by the Health Outcome Study Short Form-36. CONCLUSIONS: These angiographic and clinical improvements produced by mibefradil support a microspastic pathogenesis of the CSFP.
Authors:
John F Beltrame; Stuart P Turner; Sue L Leslie; Patty Solomon; Saul B Freedman; John D Horowitz
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  44     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-05     Completed Date:  2004-09-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  57-62     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Unit, North Western Adelaide Health Service, University of Adelaide, Adelaide, Australia. john.beltrame@adelaide.edu.au
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MeSH Terms
Descriptor/Qualifier:
Adult
Biological Markers / blood
Blood Flow Velocity / drug effects*
Blood Pressure / drug effects
C-Reactive Protein / metabolism
Calcium Channel Blockers / administration & dosage,  therapeutic use*
Coronary Angiography*
Coronary Disease / diagnosis,  drug therapy*,  physiopathology*
Coronary Vessels / physiopathology,  ultrasonography
Cross-Over Studies
Diastole / drug effects
Dose-Response Relationship, Drug
Double-Blind Method
Echocardiography
Electrocardiography, Ambulatory
Female
Heart Conduction System / drug effects,  metabolism,  physiopathology
Heart Rate / drug effects
Humans
Male
Mibefradil / administration & dosage,  therapeutic use*
Middle Aged
Patient Compliance
Statistics as Topic
Systole / drug effects
Treatment Outcome
Troponin I / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Calcium Channel Blockers; 0/Troponin I; 116644-53-2/Mibefradil; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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