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Exercise cardiovascular responses to gallopamil in ischemic heart disease
Insights
Gallopamil effectively reduced anginal attacks and improved exercise capacity in patients with chronic stable angina, similar to diltiazem. This calcium channel blocker enhanced cardiac output during exercise, offering a viable treatment option.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable angina remains a significant clinical challenge.
- Calcium channel blockers are a cornerstone in managing angina.
- Evaluating novel agents like gallopamil is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess the efficacy and cardiovascular effects of gallopamil in patients with chronic stable angina.
- To compare gallopamil's performance against diltiazem, a known calcium channel blocker.
- To investigate gallopamil's impact on exercise-induced cardiovascular responses.
Main Methods:
- A single-blind, placebo-controlled, crossover trial involving 12 patients with chronic stable angina.
- Patients received either gallopamil or diltiazem for 10-day periods after a placebo run-in.
- Hemodynamic assessments, including right heart catheterization, were performed at rest and during exercise.
Main Results:
- Gallopamil significantly reduced anginal attacks, comparable to diltiazem.
- Gallopamil improved exercise time and delayed ST-segment depression onset.
- Hemodynamic analysis showed increased cardiac index and stroke volume index during exercise with gallopamil.
Conclusions:
- Gallopamil demonstrates significant anti-anginal efficacy and improves exercise tolerance.
- Gallopamil positively influences cardiac hemodynamics during exercise.
- Gallopamil represents a promising therapeutic option for managing chronic stable angina.
Unlabelled:
In a single-blind, placebo-controlled, crossover trial versus diltiazem, we evaluated the influence of gallopamil on cardiovascular responses evoked by bicycle exercise. Twelve patients with chronic stable angina were enrolled. After a 5 days placebo run-in period, patients were randomly assigned either to gallopamil (50 mg thrice daily) or diltiazem (60 mg thrice daily) for 10 days. Then, patients were changed to the alternative drug. After placebo, and at the end of each subsequent period, all subjects underwent right heart catheterization by means of a Swan-Ganz thermodilution catheter. Hemodynamics were determined in 3 ways: supine, standing and during a multistage exercise test.
Results:
anginal attacks were reduced to a similar degree by gallopamil (2.1 +/- 1/week versus 5.8 +/- 2.8/week during placebo, p less than 0.01) and diltiazem (2.0 +/- 0.8/week versus 5.8 +/- 2.8/week during placebo, P less than 0.01). At rest, gallopamil caused a significant decrease in heart rate and a slight fall in systemic vascular resistance. Cardiac index rose during exercise and was higher with respect to placebo at peak exercise (6.7 vs 5.6 l/min/m2, P less than 0.05). As a consequence, stroke volume index and stroke work index both increased at maximum workload (P less than 0.05). Compared to placebo, exercise time was significantly improved by gallopamil (+50%, P less than 0.02) and diltiazem (+38%, P less than 0.05). Likewise, time to onset of ST-segment depression was prolonged by 70% with gallopamil (P less than 0.01) and by 64% with diltiazem (P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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