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[Hemodynamics and coronary dynamics under ISDN long-term therapy]
Insights
This study shows that sustained-release isosorbide dinitrate (ISDN) effectively improves exercise capacity and cardiac function in patients with coronary heart disease, even with long-term use.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Nitrate tolerance is a persistent challenge in cardiovascular therapy.
- Isosorbide dinitrate (ISDN) is a long-established cardiovascular drug.
- Coronary heart disease (CHD) and impaired left ventricular function require effective management.
Purpose:
- To evaluate the efficacy of initial versus chronic (4-week) therapy with 120 mg sustained-release ISDN.
- To assess hemodynamic and functional improvements in patients with CHD and impaired left ventricular function.
Summary:
- Sustained-release ISDN significantly reduced pulmonary capillary wedge pressure (PCWPm) during exercise.
- Cardiac index (CI) and exercise capacity (watt x min) showed marked improvements with both initial and chronic ISDN therapy.
- ST-segment depression on ECG decreased, indicating reduced myocardial ischemia.
Impact:
- Sustained-release ISDN demonstrates sustained efficacy in improving cardiac performance and exercise tolerance in CHD patients.
- The findings suggest that tolerance to ISDN may not be a significant issue with this sustained-release formulation.
- This research supports the continued use of ISDN in managing coronary heart disease, highlighting its long-term benefits.
Abstract:
Although nitrates are among the oldest drugs in cardiology the problem of tolerance is a scientific challenge of today. We examined and compared the effects of initial and chronic therapy (4 weeks) with 1 X 1 ISDN 120 mg sustained release in 9 patients with coronary heart disease and impaired left ventricular function. At intraindividually identical workloads (average 50 +/- 12 watt) there was a reduction of PCWPm from 32.5 +/- 9.5 to 19.7 +/- 9.8 mm Hg. This reduction of PCWPm during bicycle ergometry was fully achieved in long-term therapy. With the first dose of ISDN cardiac index (CI) at maximum workload increased from 6.0 +/- 1.2 to 6.8 +/- 1.3 l/min/m2; during chronic therapy cardiac index improved from 5.3 +/- 1.3 to 6.6 +/- 1.1 l/min/m2. Exercise capacity during bicycle ergometry in the sitting position increased concomitantly from 414 to 686 watt X min. In long-term therapy there was a further significant improvement to 772 watt X min. ST-segment depression, measured as sum of ST-depression in all 12 standard ECG leads decreased from 0.63 mV before medication to 0.11 mV after the first dose and to 0.16 mV in long-term therapy. The investigation of ventricular function during ventriculography and the investigation of coronary vasomotion during coronary angiography after ergonovine maleate i.v. and ISDN s.l. also demonstrated the full nitrate effect in long-term therapy.