Hemodynamic actions of bepridil during treatment of stable angina pectoris

Bepridil, a new calcium-entry blocker, was evaluated in 13 patients with chronic stable angina in a single-blind trial that was placebo controlled within patients. Its antianginal effects were recorded and left ventricular (LV) function was assessed at rest and during exercise by gated blood pool scintigraphy. Mean anginal frequency was significantly reduced from 7.3 to 3.4 episodes/week (p less than 0.01). Total work performed increased from 336 to 625 kpm (p less than 0.01). Supine resting LV end-diastolic volume index, end-systolic volume index, stroke volume index, cardiac index and ejection fraction (EF) were not altered by bepridil. During supine exercise, the EF decreased from 60 to 55 during placebo therapy. Despite an increase in total work, the mean EF increased from 60 to 62 (p less than 0.05 versus exercise on placebo) during exercise with bepridil therapy. Maximal exercise stroke volume index and cardiac index were significantly greater during bepridil therapy. Exercise resulted in new or increased LV wall motion abnormalities in 7 of 13 patients during placebo therapy. During bepridil therapy, only 4 new or increased wall motion abnormalities were noted despite the increase in total work performed. Therefore, bepridil is an effective antianginal agent, allowing an increase in exercise workload while preserving LV performance.