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Improvement of left ventricular function in silent ischemia following myocardial infarction, after administration of
E E van der Wall1, M G Niemeyer, H W Vliegen
1Department of Cardiology, University Hospital Leiden, The Netherlands.
Insights
Diltiazem significantly reduced asymptomatic ST-T-segment depression in post-myocardial infarction patients. This calcium channel blocker also improved both global and regional left ventricular function during exercise, benefiting those with silent ischemia.
Area of Science:
- Cardiology
- Pharmacology
- Nuclear Cardiology
Background:
- Acute myocardial infarction (AMI) patients may exhibit silent ischemia, indicated by asymptomatic ST-T-segment depression during exercise.
- Assessing left ventricular (LV) function is crucial for managing post-infarction patients.
Purpose of the Study:
- To evaluate the acute effects of diltiazem on asymptomatic ST-T-segment depression and LV function in post-AMI patients with silent ischemia.
Main Methods:
- Seventy-two AMI patients underwent predischarge exercise radionuclide angiography.
- Twenty-five patients with asymptomatic ST-T-segment depression received 120 mg oral diltiazem and repeated testing.
- LV ejection fraction (LVEF) and regional wall motion scores were assessed before and after diltiazem administration.
Main Results:
- Diltiazem reduced maximal ST-T-segment depression from 2.4 mm to 0.8 mm (p<0.01).
- Exercise LVEF improved significantly after diltiazem (42.8% to 49.1%, p<0.05).
- Regional wall motion score during exercise improved post-diltiazem (5.9 to 4.2, p<0.02).
Conclusions:
- Diltiazem demonstrates acute beneficial effects on silent myocardial ischemia in post-infarction patients.
- The drug improves global and regional left ventricular function during exercise in this population.
Abstract:
In a group of 72 patients with acute myocardial infarction who underwent a maximal symptom-limited predischarge exercise test in conjunction with radionuclide angiography, 25 (35%) showed greater than 1 mm asymptomatic ST-T-segment depression during exercise. All 25 patients underwent repeated exercise radionuclide angiography 2 days later, 2 h after oral intake of 120 mg diltiazem. Double product was not significantly different before and after diltiazem both at rest and during exercise. Maximal ST-T-segment depression after diltiazem was reduced from 2.4 +/- 0.9 mm to 0.8 +/- 0.6 mm (p less than 0.01). Left ventricular ejection fraction (LVEF) at rest was (before diltiazem) 52.1 +/- 8.9% and (after diltiazem) 55.1 +/- 12.3% (NS). During exercise, LVEF improved after diltiazem from 42.8 +/- 12.1% to 49.1 +/- 10.8% (p less than 0.05). Regional wall motion score (1 = normal, 2 = hypokinetic, 3 = akinetic, 4 = dyskinetic) at rest before diltiazem was 9.9 +/- 2.3 and, after diltiazem, was 9.0 +/- 1.9 (NS). During exercise, regional wall motion score improved after diltiazem from 5.9 +/- 1.3 to 4.2 +/- 1.2 (p less than 0.02). We conclude that diltiazem has acute beneficial effects on asymptomatic ST-T-segment depression and on global and regional left ventricular function in post-infarction patients with silent ischemia.