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Amlodipine reduces myocardial ischaemia during exercise without compromising left ventricular function in patients
J Bech1, J K Madsen, H Kelbaek
1Department of Clinical Physiology/Nuclear Medicine, Copenhagen University Hospital, Herlev, Denmark. jbech@dadlnet.dk
Insights
Amlodipine, an anti-ischaemic drug, did not alter left ventricular systolic function during rest or exercise in patients with silent ischaemia. This study indicates amlodipine is safe for cardiac function in this patient group.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Coronary artery disease (CAD) patients exhibit reduced left ventricular systolic function during silent ischaemia.
- Left ventricular ejection fraction (LVEF) typically increases with exercise in healthy individuals, but often remains unchanged or decreases in CAD patients.
- The impact of calcium antagonists on left ventricular volume changes during exercise in silent ischaemia remains unclear.
Purpose of the Study:
- To assess the effect of amlodipine on resting and exercise LVEF in patients experiencing silent ischaemia.
- To evaluate amlodipine's influence on cardiac function in the context of silent ischaemia.
Main Methods:
- A double-blind, placebo-controlled, cross-over study involving 21 patients.
- Utilized conventional exercise testing and radionuclide cardiography during exercise to measure hemodynamic parameters.
Main Results:
- Amlodipine reduced exercise-induced ST-depressions in 83% of patients with ST-deviations, even in those on beta-blockers.
- No significant difference in left ventricular systolic function was observed between amlodipine and placebo, at rest or during exercise.
Conclusions:
- Amlodipine demonstrates safety concerning cardiac function in patients with silent ischaemia.
- The drug appears to be a safe anti-ischaemic option for managing silent ischaemia without negatively impacting cardiac performance.
Background:
Left ventricular systolic function is reduced during episodes of silent ischaemia in patients with coronary artery disease (CAD). In most normal subjects left ventricular ejection fraction (LVEF) increases at least 5% during exercise whereas LVEF often remains unchanged or decreases in patients with CAD. The anti-ischaemic effect of calcium antagonists is well documented including a capability to reduce exercise-induced electrocardiographic ST-depressions, whereas the effect of these drugs on LV volume changes during exercise in patients with silent ischaemia is unknown.
Aim:
The aim of this study was to evaluate the effect of amlodipine on rest and exercise LVEF in patients with silent ischaemia.
Methods:
Twenty-one patients completed a double-blind placebo-controlled cross-over study. Conventional exercise test and radionuclide cardiographies during exercise were used for determining haemodynamic parameters.
Results:
Exercise-induced electrocardiographic ST-depressions were reduced in 83% of the patients having ST-deviations during placebo even though 10 patients were already treated with a beta-blocker. Amlodipine did not affect left ventricular systolic function compared to placebo, neither at rest nor during exercise.
Conclusion:
The results indicated that amlodipine is a safe anti-ischaemic drug in patients with silent ischaemia concerning cardiac function.