On The Effect Of Diltiazem In The Treatment Of Microvascular Angina And Its Mechanism

Objective: Observe the curative effect of calcium antagonist-diltiazemon microvascular angina treatment, and to study the possible mechanism ofmicrovascular angina.Methods:51(15males and36females respectively) patients were selectedas objects of the study who were diagnosed as cardiac syndrome X fromJanuary to November in2012in the second heart department of The ThirdHospital of Hebei Medical University. Those patients with cardiomyopathy,valvular heart disease, pericarditis, hypertension or hypertensive heart diseasewhich can cause angina were excluded,patients with some other diseases, sortof esophagus, chest or lung diseases, which can cause non-cardiac chest painand patients who suffer contraindication of basic drugs with slow heartbeat orgastrointestinal bleeding were excluded also. All objects were divided into thestudy group (30cases included) and control group (21cases included)withcompletely randomly. All objects were prescribed with aspirin, statins, Betalocfor a basic treatment, while the study group received diltiazem capsuleadditionally during the span of4months’ treatment, At the same time, otherrelevant drugs were ready for treating complications. CFR, ET-1, NO weremeasured in all the objects before and after treatment, as well as the treadmillexercise test were observed before and after treatment, to observe the changesof CFR, ET-1, NO and exercise tolerance.Results: For all objects, the number of patients with chest pain weresignificantly lower than that of before treatment,effective rate in studygroup81.67%by control group61.90%, have significant difference (P<0.05)about efficiency. The time about ECG exercise test from beginning to STdepressed0.1mv both were prolonged, there are significant differencesbetween before and after treatment either study group or control group(study group:252±72vs.324±90s.P<0.05, control group:246±72vs.294+78.P<0.05),there are also significant differences in the study group compared withthe control group after4months (324±90vs.294+78s. P<0.05), ST segmentdepression duration of the experiment group and the control group wereshortened, within group comparisons were significant difference (study group:72±28.6vs. P<0.05, control group:73±29.4vs.54±18.0s,P<0.05), between thetwo groups comparisons (42±14.4vs.54+18.0s,P<0.05). Coronary flow reserve(CFR) is significantly improved of study groups (2.2±0.6vs.2.6±0.6, P<0.05),but not have significant improvement in control group (2.2±0.5vs.2.3±0.6,P>0.05), and between the two groups there is significant difference(2.6±0.6vs.2.3±0.6, P <0.05). On the ET-1, whether within group comparisonsor comparisons between groups were significant differences (the study group:70±7vs.62±8umol/l, P<0.05; the control group:72±9vs.66±9umol/l,P<0.05;comparison between groups:62±8vs.66±9umol/l,P<0.05),But the NO, havesignificant difference within groups nor no difference among groups(studygroup:54±20vs.59±19mg/l, P<0.05;55±20vs.57±18mg/l,P<0.05;comparison between groups:59±19vs.57±18mg/l, P>0.05).Conclusion: Calcium antagonist diltiazem can significantly improve theCSX patient’s symptoms of chest pain, can significantly improve the exercisetolerance in patients with CSX, Can markedly dilated cardiac microvascular,can improve the arteriolar reserve function obviously, its antioxidant,anti-inflammatory and anti-atherosclerosis effect, can improve the arterialendothelial function, can reduce the ET-1released by vascular endothelial,properly increasing the NO, has a good effect in treatment of CSX.