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Degrees in the coronary flow impairment related to therapy and diastolic dysfunction in patients with non-obstructive coronary artery disease
N Emilova1
,
S Denchev2
,
1"LORAMED" Medical Centre - Sofia - Bulgaria
,
2Medical Insitute of the Ministry of Internal Affairs, Clinic of Cradiology - Sofia - Bulgaria
,
Topic(s): Acute Coronary Syndromes – Prevention
Purpose: We performed an analysis of the degrees in coronary flow impairment related to the type of anti-ischemic therapy and the presence of diastolic dysfunction in symptomatic patients with non-obstructive coronary artery disease.
Material and methods: Seventy-nine patients (normal flow, NF – n=17) with coronary stenoses less than 50% admitted to the University Hospital with unstable angina and acute non-ST-elevation coronary syndrome during 2006-2008 received evaluation of the following angiographic coronary flow indices: corrected TIMI frame count - cTFC and systolic reversal of coronary flow - SARC, n=58, 73.4%. Diastolic function was assessed in all patiens with the use of tissue Doppler echocardiography. Patients with ejection fractions<50%, moderate or severe valve disease, valve prolapse were excluded from the study. Non-selective beta-receptor antagonists (BB) and BB with vasodilating properties were used only combined with calcium channel antagonist (CCB) and long-acting nitrate (N).
Results: The incidence of diastolic dysfunction (DD) was 60%, n=27 (NF – 6.3%, n=5). The patients with resting coronary flow abnormalities and DD received more commonly BBs as monotherapy compared to those without DD (77.8%, n=14 vs 26.7%, n=5, p=0.029) and remained with significant delay in flow velocity (35.3±12.1 vs 24.4±8.9 frames, p=0.006 for cTFC; 26.3% (n=5) vs 7.7% (n=1), p - NS for SARC). Compared to therapy with BB alone, the intake of BB+CCB and BB+CCB+N were associated with more favorable flow indices that were comparable in the groups with and without DD (cTFC - 25.8±6 (n=8) vs 26.5±9.8 frames (n=8), p=0.856; SARC – 16% (n=1) vs 0% (n=0), p-NS for BB+CCB; cTFC – 25.9±6.1 (n=11) vs 27±9.3 (n=9) frames, p=0.756; SARC – 11.1% (n=1) vs 0% (n=0), p-NS for BB+CCB+N).
Conclusions: In a population with non-obstructive coronary disease consisting mostly of patients with impaired flow at rest the intake of calcium channel antagonist is associated with improved coronary flow at rest in the subset with diastolic dysfunction.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
