Exercise tolerance in coronary patients: randomized trial of two-week treatment with molsidomine versus placebo

Using a randomized, double-blind, crossover protocol, we compared the effects of oral molsidomine (Corvaton, 6 mg/day) and placebo, administered alternately for two 14-day periods, on the exercise tolerance of 25 outpatients with coronary heart disease. Resting heart rate and oxygen consumption increased by 6.8% (p less than 0.005) and 12.6% (p less than 0.01), while peripheral systolic blood pressure was reduced by 5.1% (p less than 0.05). At submaximal workloads, systolic and diastolic blood pressures were reduced by 5.6% (p less than 0.001) and 6.1% (p less than 0.001), the pressure-rate product was reduced by 8.5% (p less than 0.05), and ST segment depression was reduced by 40.0% (p less than 0.005). At maximal exercise level, mechanical power increased by 32.4% (p less than 0.001) and oxygen consumption by 15.5% (p less than 0.005), while ST segment depression was reduced by 30.6% (p less than 0.001). No alteration was found in postexercise lung function tests. It is concluded that molsidomine reduces myocardial ischemia at both submaximal and maximal work levels and increases exercise tolerance significantly. These effects could be related to reduced myocardial oxygen requirements, reflected in a lower pressure-rate product at submaximal exercise and perhaps enhanced by a lower preload, which, moreover, would favor coronary flow in subendocardial layers. The drug has no adverse bronchopulmonary effects.