HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beltrame, J. F. Articles by Horowitz, J. D. Search for Related Content PubMed PubMed Citation Articles by Beltrame, J. F. Articles by Horowitz, J. D.

CLINICAL RESEARCH: CORONARY ARTERY DISEASE

The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon

John F. Beltrame, BSc, BMBS, FRACP, PhD, FESC, FACC^*,*, Stuart P. Turner, BMed, FRACP^*, Sue L. Leslie, RN^*, Patty Solomon, BSc, Dip Maths Stats, PhD, Saul B. Freedman, MBBS, FRACP, PhD, FACC and John D. Horowitz, MBBS, BMed Sci, PhD, FRACP^*

^* Cardiology Unit, North Western Adelaide Health Service, University of Adelaide, Adelaide, Australia
School of Applied Mathematics and ARC Special Research Centre for Molecular Genetics of Development, University of Adelaide, Adelaide, Australia
Department of Cardiology, Concord Repatriation General Hospital, and Anzac Research Institute, University of Sydney, Sydney, Australia

Manuscript received December 31, 2003; revised manuscript received March 5, 2004, accepted March 16, 2004.

^* Reprint requests and correspondence: Dr. John F. Beltrame, Cardiology Unit, North Western Adelaide Health Service, The Queen Elizabeth Hospital Campus, 28 Woodville Road, Woodville South SA 5011, Australia.
john.beltrame{at}adelaide.edu.au

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.

Abbreviations and Acronyms   CSFP = coronary slow flow phenomenon   CTFC = corrected TIMI frame count   ECG = electrocardiogram   LAD = left anterior descending artery   SF-36 = Health Outcome Study Short Form-36   TIMI = Thrombolysis In Myocardial Infarction