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Additional antianginal efficacy of amiodarone in patients with limiting angina pectoris
Insights
Amiodarone significantly improved exercise capacity and reduced symptoms in patients with stable angina refractory to conventional triple therapy. This antianginal therapy combination was well tolerated, offering a new treatment option.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable angina pectoris (NYHA class III) with persistent symptoms despite triple therapy poses a clinical challenge.
- Limited treatment options exist for patients with refractory angina.
Purpose of the Study:
- To evaluate the efficacy and safety of amiodarone as an add-on therapy for patients with stable angina experiencing limiting symptoms despite conventional triple therapy.
- To assess amiodarone's impact on exercise capacity and cardiac workload.
Main Methods:
- A double-blind, randomized controlled trial involving 63 patients with stable angina (NYHA class III) and positive stress tests.
- Patients received either amiodarone (graduated dosage) or placebo for 2 months, alongside their existing triple antianginal therapy.
- Exercise duration, double product, and ST segment depression were measured at baseline, 1 month, and 2 months.
Main Results:
- Amiodarone significantly increased exercise duration compared to placebo at both 1 and 2 months (p < 0.05).
- The amiodarone group showed a significant reduction in double product at 1 and 2 months (p < 0.001) compared to placebo.
- Significant reduction in ST segment depression at peak exercise was observed with amiodarone therapy.
Conclusions:
- Combination therapy with amiodarone and conventional antianginal agents is well-tolerated.
- Amiodarone significantly improves exercise capacity and mildly reduces symptoms in patients with refractory angina.
- Amiodarone represents a viable therapeutic option for managing persistent angina pectoris despite optimal conventional treatment.
Abstract:
Sixty-three patients with stable angina New York Heart Association (NYHA) class III and a positive stress test despite triple therapy were randomized to a double-blind protocol, receiving either placebo or amiodarone in a dose of 600 mg/day for 10 days, followed by 400 mg/day for an additional 10 days, and then by 200 mg/day over a total period of 2 months. Comparable bicycle exercise times were observed at baseline in the amiodarone group (6.0 +/- 1.6 minutes) and in the placebo group (6.0 +/- 1.8 minutes). With amiodarone, there was a increase in exercise duration of 6.7 +/- 2.2 minutes versus 6.3 +/- 2.2 minutes at 1 month and 7.5 +/- 2.1 minutes versus 6.2 +/- 1.7 minutes at 2 months (p < 0.05). Also, the amiodarone group had a significant decrease in the double product when compared with the placebo group at 1 month (14,134 +/- 3,316 versus 17,570 +/- 4,092 mm Hg/min, p < 0.001) and at 2 months (14,022 +/- 3,303 and 17,298 +/- 4,872 mm Hg/min, p < 0.001). The degree of ST segment depression at peak exercise was also significantly reduced. Combination therapy of amiodarone with conventional antianginal therapy is well tolerated and results in a significant improvement in exercise capacity and a mild reduction of symptoms in patients who have continued, limiting angina pectoris with conventional triple therapy.