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Coronary artery dilation and hemodynamic responses after isosorbide dinitrate therapy in patients with coronary artery disease

1985; Elsevier BV; Volume: 56; Issue: 7 Linguagem: Inglês

10.1016/0002-9149(85)90872-0

1879-1913

Rodney S. Badger, B. Greg Brown, Christian A. Gallery, Edward L. Bolson, Harold T. Dodge,

Cardiac electrophysiology and arrhythmias

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 < 0.01) in pulmonary capillary wedge pressure and a 15% decrease (p < 0.05) in systemic and pulmonary vascular resistance, with a net 13% decrease (p < 0.01) in cardiac output and 20% decrease (p < 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 < 0.01), 29% (p < 0.01) and 16% (p < 0.05), respectively. Diseased epicardial segments (stenosis 50% or greater) dilated 51% (p < 0.01) at 10 minutes. Calculated stenosis resistance decreased 40% (p < 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 < 0.01) at 30 minutes. These responses occurred within 3 minutes after ISDN administration, peaked at 10 minutes and persisted, unchanged, for the remaining 20 minutes. The response of epicardial arteries to ISDN is the maximum observed with any coronary vasodilating drug.