Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina (original) (raw)
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The American Journal of Cardiology, 1982
To assess the effects of nifedipine on left ventricular function and regional myocardial perfusion, exercise radionuclide ventriculography was performed in 15 men (median age 59 years) and exercise thallium-201 scintigraphy was done in 11 of them, before and 90 minutes after the oral administration of 20 mg of nifedipine. All patients had stable angina and angiographically proved coronary artery disease without evidence of spasm. Exercise tolerance after administration of nifedipine increased from 343 f 42 seconds to 471 150 seconds (p <0 .01), whereas the peak exercise double product remained essentially unchanged (difference not significant). Ejection traction improved significantly at rest (from 49 f 3 .6% to 52 f 3 .3%, p <0 .05) and at peak Nifedipine is a calcium antagonist with potent vasodilating properties.)-1 It has been used successfully in the treatment of stable angina pectoris and other ischemic syndromes 5-10 and has also been noted to have a negative inotropic effect in the isolated cardiac muscle preparation. 11 However, reports on its effects on myocardial function in patients with cardiac disease have been conflicting. 12-14 In particular, its possible influence on the acute left ventricular dysfunction resulting from stress-induced ischemia has not been sufficiently investigated. The present study was designed to assess the effects of nifedipine on left ventricular function at rest and during exercise in patients with coronary artery
Journal of the American College of Cardiology, 1986
The effects of nifedipine on arterial oxygenation and hemodynamics were studied at rest and during bicycle exercise in 12 men (mean age 55 years, range 41 to 67) with stable exertional angina. The study was conducted double-blind on 2 days, 1 week apart, using a placebocontrolled crossover design. On each day, measurements at rest were made before and 20 minutes after 20 mg sublingual nifedipine or placebo and were followed by measurements made during exercise. Compared with placebo, nifedipine reduced mean arterial pressure, systemic vascular resistance and pulmonary vascular resistance, and increased heart rate and cardiac output at rest and during exercise. It did not alter mean pulmonary artery or pulmonary artery wedgepressures at rest, but decreased them during exercise.
Effects of felodipine versus nifedipine on exercise tolerance in stable angina pectoris
The American Journal of Cardiology, 1994
The effects of single doses of felodipine (5 and 10 mg) and nifedipine (10 and 20 mg) on chronic stable effort angma pectoris were assessed in a placebocontrolled, doubleblind, crossover study of 24 patients receiving 6 blockers and shortacting nitroglycerin. The effects were measured by repeated bicycle ergometer tests. The total work, and time until 1 mm of ST depression increased significantly by 9 to 31% after both active drugs at both dose levels in comparison with placebo. The differences were not significant between drugs or doses. At rest, blood pressure decreased (10 to 15%) and heart rate increased (5 to 10%) significantly after both ae tive drugs. During exercise at the highest comparable work load, systolic blood pressure decreased significantly (23 to 26%), whereas heart rate was not affected after felodipine and nifedipine compared with placebo. The 2 drugs were well tolerated, and side effects were mild. Therefore, single doses of 5 and 10 mg of felodipine, and 10 and 20 mg of nifediplne have similar antianginal and anti-ischemic properties. However, felodipine has a longer duration of action, which may improve compliance.
International Journal of Cardiology, 1986
GP, D'Ermo M, Mattioli M, Lioy E, Biffani G. The response of the coronary collateral circulation to acute administration of nifedipine: an angiographic and ergometric study. Int J Cardiol 1986;11:25-36. To evaluate the role of collaterals in patients with effort angina we retrospectively compared the coronary cineangiograms of 14 subjects ("responders") who improved their exercise tolerance after acute nifedipine therapy with 14 subjects ("non-responders") with the same symptomatology who did not respond to the same treatment. The status of collaterals was graded with a score from a minimum of 0 to a maximum of 5. The responders showed a greater score than the non-responders (3 f 1 vs. 1 f 1, P < O.OOl), whereas there was no difference in the number of steno& vessels between the two groups (1.8 f 0.9 vs. 2 f 0.8). Thus, in patients with effort angina and critical coronary stenosis, the presence of an efficient coronary collateral circulation can favour the increase in coronary flow reserve after vasodilator therapy. Our results suggest that the grading of collaterals may add useful information to the simple classification of one-, two-or three-vessel coronary artery disease.
The American Journal of Cardiology, 1984
Exercise tolerance 1, 3 and 8 hours after 80 mg of propranolol, 120 mg of diltiazem and 20 mg of nifedipine, and after 20 minutes of 0.6 mg of sublingual nitroglycerin were compared with placebo in 15 men who had chronic stable angina pectoris. Three hours after drug ingestion, the exercise time was prolonged by 72 f 26,162 f 27 and 161 f 30 seconds (p <0.05) for propranolol, diltiazem and nifedipine, respectively, and by 123 f 35 seconds (p <O.OOl) 20 minutes after sublingual nitroglycerin compared with placebo. The onset of ST-segment depression 20.1 mV was delayed by 120 f 34,203 f 29 and 189 f 35 seconds (p <O.OS) and by 79 f 23 seconds (p <0.05), respectively. Afler propranolol, the peak rate-pressure product decreased compared with placebo (15.1 f 1.1 U [10B3] vs 20.0 f 1.5 U, p <O.Ol). In contrast, the peak rate-pressure product was greater after diltiazem and nifedipine than after placebo (22.2 f 1.3 U [p <O.OSl and 23.8
American Heart Journal, 1987
ov exercige with v6br with chronic st To examine the effects of chronic oral therapy with verapamii, 120 mg three times a day, and nifedipine, 20 mg four times daiiy, on left ventricular ejection fraction and regional wail motion at rest and exercise, 10 patients with chronic stable angina pectoris underwent serial rest and exercise radionuctide angiography. Pre drug control study reveaied a resting left ventricular ejection fraction (LVEF) of 0.62 ? 0.08, faiiing to 0.54 + 0.12 at peak exercise (p < 0.05). Wail motion score deteriorated from a resting vatue of 13.8-t 2.3 to 10.8 + 1.8 (p < 0.01) with exercise. Patients were subsequently randomized to verapamii or nifediptne for 4 weeks each in an open-labeled crossover design. Rest and exercise radionuciide angtography were repeated at the end of each 4-week period. Neither verspamii nor nifedtpine had a significant effect on resting LVEF (verapamii LVEF = 0.81 + 0.10, nifedipine LVEF = 0.84 f 0.02). Likewise, they had no significant effect on resting wail motion score (verapamii = 14.2-+ 2.2, nifedipine = 14.4 f 1.8). Both verapamii and nifedipine signpicantiy increased LVEF at peak exercise (verapamii = 0.63 + 0.09, nifedipine = 0.65 + 0.08, p < 0.05 vs pre drug control) and improved peak exercise wail motion score (verapamii = 13 ? 1.9, nifedipine = 13.8 f 1.6, p < 0.05 vs pre drug control). Both drugs significantly reduced maximal ST depression at peak exercise and prolonged exercise duration. Episodes of angina and nitroglycerin use were also significantly reduced. in summary, verapamii and nifedipine improved left ventricular performance at exercise in patients with angina pectoris. (AM HEART J 1987; 113:700.