Circulation, Vol 77, 1022-1029, Copyright © 1988 by American Heart Association
M Fujita, S Sasayama, H Asanoi, H Nakajima, O Sakai and A Ohno
It has been demonstrated in animal experiments that heparin accelerates the
coronary collateral development induced by repeated coronary occlusion. We
used this effect of heparin for the treatment of patients with stable
effort angina. In 10 patients, treadmill exercise was performed according
to standard Bruce protocol twice a day for 10 days. A single intravenous
dose of heparin (5000 IU) was given 10 to 20 min before each exercise
period. Exercise with heparin pretreatment increased the total exercise
duration from 6.3 +/- 1.9 (SD) to 9.1 +/- 2.2 min (p less than .001) and
the maximal double product (DP) from 18,900 +/- 5100 to 25,500 +/- 6800 mm
Hg.beats/min (p less than .001). The DP at the onset of angina was also
increased by 35% (p less than .01) and the DP at which ST depression (0.1
mV) first appeared was 19% (p less than .05) greater after treatment.
Repeat coronary cineangiography revealed an increase in the extent of
opacification of collaterals to the jeopardized myocardium. In an
additional six patients, treadmill exercise was performed with no
medication twice a day for 10 days. All of the above-mentioned variables of
treadmill capacity remained unchanged, despite 20 exercise periods without
heparin pretreatment. Thus, heparin accelerates exercise-induced coronary
collateral development by promoting angiogenesis. The development of such a
therapeutic modality will open a new field for the treatment of patients
with ischemia.
ARTICLES
Improvement of treadmill capacity and collateral circulation as a result of exercise with heparin pretreatment in patients with effort angina
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
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