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.