In a randomized trial of patients with angina and no obstructive Coronary artery disease(ANOCA), 6 weeks of treatment with diltiazem did not improve coronary vasomotor dysfunction — apart from epicardial spasm — or angina symptoms and quality of life.
The trial investigated whether this therapy would improve these outcomes in patients with two endotypes of coronary vasomotor dysfunction: coronary artery spasm (epicardial spasm, microvascular spasm) or coronary microvascular dysfunction indicated by coronary flow reserve (CFR) and index of microvascular resistance (IMR) values.
Treatment success, the primary study endpoint — defined as normalization of one of the abnormal endotypes and no normal endotype becoming abnormal — was similar after treatment with diltiazem compared to placebo. Nor were there significant differences for secondary endpoints apart from improvements in epicardial spasm in the two groups.
Tijn Jansen, MD, presented these findings from the Efficacy of Diltiazem to Improve Coronary Microvascular Dysfunction: A Randomized Clinical Trial (EDIT – CMD ) in a featured clinical research session at the American College of Cardiology (ACC) 2022 Scientific Session in Washington, DC. The study was simultaneously Published online April 2 in JACC Cardiovascular Imaging.
“This first study using repeated coronary function testing provides a platform for future research,” Jansen, a PhD candidate in the Department of Cardiology, Radboud University, Nijmegen, the Netherlands, concluded
We did find a treatment success, however, of 21%, which was slightly lower than expected, but it was not better than just giving placebo. This was similar regarding symptoms and quality of life, where we did find an overall improvement with diltiazem, but again not higher than using placebo,” he added. “It seems that giving the diagnosis to these patients itself creates a reduction in symptoms,” that might be due to a reduction in stress, Jansen suggested.
The clinical implication, he said, is that more randomized controlled trials in this patient population are needed to permit evidence-based patient-tailored treatment, based on the different endotypes. “It might even be imaginable to test effectiveness in each individual patient using coronary function testing”.
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