YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==CALCIUM - CORONARY, TEST== 1 AUTHOR San Roman JA AUTHOR Vilacosta I AUTHOR Castillo JA AUTHOR Rollan MJ AUTHOR Peral V AUTHOR Sanchez-Harguindey L AUTHOR Fernandez-Aviles F TITLE Dipyridamole and dobutamine-atropine stress echocardiography in the diagnosis of coronary artery disease. Comparison with exercise stress test, analysis of agreement, and impact of antianginal treatment. SOURCE Chest; VOL 110, ISS 5, 1996, P1248-54 ABSTRACT STUDY OBJECTIVES: To compare the usefulness of dipyridamole echocardiography, dobutamine-atropine echocardiography, and exercise stress testing in the diagnosis of coronary artery disease and to analyze the agreement among the tests. DESIGN: Performance of these three tests in random order on a consecutive cohort of patients. SETTING: A tertiary care and university center. PATIENTS: One hundred two consecutive patients with chest pain and no history of coronary artery disease. INTERVENTIONS: Dipyridamole echocardiography, dobutamine-atropine echocardiography, exercise stress testing, and coronary angiography. MEASUREMENTS AND RESULTS: Dobutamine-atropine test was positive in 49 (77%) of 63 patients with coronary artery disease, dipyridamole test in 49 (77%), and exercise stress test in 44 (68%; p = NS). Both echocardiographic tests showed an overall specificity (dipyridamole, 97%; dobutamine, 95%) higher than exercise stress test (79%; p < 0.05). Sensitivity of dipyridamole testing decreased from 93 to 61% (p = 0.002) if patients were receiving antianginal treatment but sensitivity of dobutamine-atropine testing was not affected (77% in patients receiving and not receiving treatment). When results were considered as positive-negative, agreement between dipyridamole and dobutamine-atropine echocardiography was 85% (kappa = 0.70). With regards to regional analysis, concordance was good (93% for segments, kappa = 0.76; and 95% for coronary arteries, kappa = 0.92). Major complications were more frequent during dobutamine-atropine (n = 7) than during dipyridamole infusion (n = 2) (p = 0.06). CONCLUSIONS: Dobutamine-atropine and dipyridamole echocardiography have a similar sensitivity and a higher specificity than that obtained by exercise ECG for the diagnosis of coronary artery disease. Similar information is obtained with dipyridamole and dobutamine-atropine echocardiography. It is our thought that pharmacologic stress echocardiography should be used as a first-step test to rule out coronary artery disease in patients not capable of exercising. 12 AUTHOR Previtali M AUTHOR Panciroli C AUTHOR Ardissino D AUTHOR Chimienti M AUTHOR Angoli L AUTHOR Salerno JA TITLE Spontaneous remission of variant angina documented by Holter monitoring and ergonovine testing in patients treated with calcium antagonists. SOURCE Am J Cardiol; VOL 59, ISS 4, 1987, P235-40 ABSTRACT Twenty-four patients with Prinzmetal's variant angina showing a favorable initial response to calcium antagonist treatment were studied to assess the evolution of the disease and the frequency and time course of spontaneous remission. At 3, 6 and 12 months from the acute phase, patients underwent in-hospital control studies, with 48-hour Holter monitoring and ergonovine testing carried out during treatment and after its interruption. During calcium antagonist therapy complete protection from spontaneous attacks was documented in 22 of 24 patients at 3 months, in 19 of 21 at 6 months and in all 21 at 12 months; ergonovine test results were negative in 16 of 23 patients at 3 months, in 16 of 20 at 6 months and in all 20 studied at 12 months. After stopping treatment spontaneous attacks did not reappear in 7 of 24 patients (29%), 14 of 21 (66%) and 16 of 21 (76%) at 3, 6 and 12 months respectively, while the ergonovine test response remained negative in 6 of 21 (28%), 7 of 18 (39%) and 13 of 20 (65%) of the patients controlled at 3, 6 and 12 months. Thus, complete remission of angina documented by both Holter recording and ergonovine testing occurred in 5 of 24 patients (21%) at 3 months, in 7 of 21 (33%) at 6 months and in 12 of 21 (57%) at 12 months. Patients with remission of angina had a shorter duration of symptoms and more often showed normal or not critically diseased coronary arteries.(ABSTRACT TRUNCATED AT 250 WORDS) 13 AUTHOR Bory M AUTHOR Marie P AUTHOR Calaf R AUTHOR Sainsous J AUTHOR Djiane P AUTHOR Serradmigni A TITLE [Prognostic value of coronary spasm threshold determined by the ergometrine test] SOURCE Arch Mal Coeur Vaiss; VOL 77, ISS 13, 1984, P1462-7 ABSTRACT The prognosis of spastic angina is difficult to determine. The object of this study was to try to evaluate the prognosis of coronary spasm on the results of provocative, ergometrine testing. Out of 708 patients with angiographically normal or near-normal coronary arteries undergoing the ergometrine test for assessment of chest pain, 78 patients with positive results were retained for study. The threshold of spasm was established in every case: this was defined as the quantity of ergometrine per kilogramme body weight required to provoke spasm. The values ranged from 1 to 12.5 micrograms/kg (average 7.58 micrograms/kg +/- 3.84). The reproducibility of the ergometrine test appeared to be very satisfactory. In the short term, only 4 out of 32 tests became negative. The test remained positive in 28 cases and the mean value of the threshold of spasm did not change significantly (5.64 +/- 3.27 to 5.52 +/- 3.18 micrograms/kg). In the long term only 2 out of 18 tests became negative. The test remained positive in 16 cases and the mean value of the threshold of spasm did not change significantly (5.68 +/- 2.96 to 6.58 +/- 3.11 micrograms/kg). The ergometrine test with a reference threshold of positivity of 5 micrograms/kg is doubly useful: this threshold value helps predict a good response to calcium inhibitor drugs: the threshold of spasm was less than this value in 6 of the 41 patients whose tests became negative after diltiazem therapy, and in 12 of 14 patients in whom the test remained positive (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) 13 AUTHOR Brown BG TITLE Response of normal and diseased epicardial coronary arteries to vasoactive drugs: quantitative arteriographic studies. SOURCE Am J Cardiol; VOL 56, ISS 9, 1985, P23E-29E (REF: 37) ABSTRACT Coronary vasodilators known to be effective in effort and vasospastic angina were studied in 93 patients undergoing catheterization for evaluation of chest pain. The ischemia-provoking stresses were isometric handgrip (25% of maximum for 4 to 5 minutes) or ergonovine maleate (0.2 mg intravenously). Hemodynamic changes and changes in angiographic diameter of epicardial coronary arteries were measured during these stresses, with and without drug administration. Drugs included intravenous diltiazem (0.25 mg/kg load + 0.003 mg/kg/min), intravenous verapamil (0.14 mg/kg load + 0.0075 mg/kg/min) and intracoronary (0.012 mg/min X 4 minutes) and sublingual (0.4 mg) nitroglycerin. From these studies, the following statistically valid conclusions were reached. First, nitroglycerin is a potent dilator of epicardial coronary arteries, increasing normal luminal area an average of 28% and luminal area in significantly stenotic segments by 29%. Second, verapamil and diltiazem are nonsignificant epicardial coronary dilators (9% and 4% luminal area increase, respectively). Similarly, diltiazem does not dilate significant coronary stenoses. Third, sustained isometric handgrip increases systemic blood pressure and heart rate by reflex activation of the sympathetic nervous system. By this means, handgrip also constricts luminal area in normal and diseased coronary segments by 20% and 22%, respectively. One result of these changes is a handgrip-induced, ischemic 56% rise in pulmonary wedge pressure in patients with significant stenosis. Fourth, intracoronary nitroglycerin, in very small doses, does not block the systemic hemodynamic response to handgrip, but prevents handgrip-induced coronary constriction and the associated ischemic left ventricular dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS) 1 AUTHOR Fodor JG AUTHOR Boulet AP AUTHOR Savard D AUTHOR Nadeau C AUTHOR Rakusan K AUTHOR Chockalingam A AUTHOR Langer A TITLE The role of diltiazem in treating hypertension and coronary artery disease: new approaches to preventing first events. SOURCE Can J Cardiol; VOL 13, ISS 5, 1997, P495-503 (REF: 85) ABSTRACT OBJECTIVE: To review the role of diltiazem in treating and preventing a group of cardiovascular diseases, including painful and silent cardiac ischemia, stroke, nonfatal myocardial infarction and sudden cardiac death, by modulating certain physiological causes that they appear to share. DATA SOURCES: A MEDLINE search was conducted for all clinical articles on the use of diltiazem for hypertension and coronary artery disease. When clinical data were not available, basic research findings were reviewed. DATA EXTRACTION AND SYNTHESIS: Because many cardiovascular events show a marked daily periodicity--which appears to coincide with circadian peaks in the ability of platelets to aggregate, sympathetic activity, coronary tone, blood pressure, heart rate and hematocrit, and a trough in fibrinolytic activity--the impact of diltizazem on these physiological changes was assessed. CONCLUSIONS: Diltiazem influences many of these events by increasing myocardial bloodflow, and reducing myocardial oxygen demand and cardiac workload. However, it differs from other calcium antagonists in its mild negative inotropic and moderate negative dromotropic effects, without apparent stimulation of cardiac performance or contractility. In addition, it inhibits platelet aggregation, decreases catecholamine release, diminishes coronary tone and blocks the vasoconstrictive actions of endothelin-1. This appears to translate into a beneficial effect on ischemia, thrombolysis, arrhythmias, infarct parameters, atherosclerosis and hypertension. Diltiazem has a relatively favourable safety and tolerability profile, and is available in a once-daily dosage form. The most common adverse effects are related to vasodilation (eg, edema and headache), and the most frequent serious adverse event is atrioventricular block, which occurs rarely. In summary, diltiazem appears to be well suited to preventing the first occurrence of cardiovascular events and may even have a role in preventing certain types of secondary events. The data accumulated so far indicate the need for a large scale random clinical trial addressing these outcomes.