Amlodipine reduces myocardial ischaemia during exercise, without compromising left ventricular function in patients with silent ischaemia

Systolic function is often compromised during episodes of ischaemia in patients with coronary artery disease. Resting left ventricular ejection fraction (LVEF) is typically normal, while the exercise LVEF-response is abnormal. i.e. increments in LVEF of less than 5%. Most of the anti-ischaemic drugs like belablockers or calciumantagonists. which are the drugs of choice, when treating silent ischaemia (SI), do have a negative inotropic effect. The anti-ischaemic effect of amlodipine is well known, and it works without decreasing LVEF at rest The effect of amlodipine on LVEF during exercise is unknown. Purpose: to evaluate the effect of amlodipine on 1)resting/exercise LVEF, 2)electrocardiographic ischaemic ST-deviations, in patients with SI. Methods: twenty-one patients with SI. diagnosed by ST-depressions on exercise test and a history of CAD were evaluated in a double-blind placebo-controlled cross-over study, using isotope ventriculography ("exercise-MUGA"). Results: mean LVEF(%)* (Exercise) Number of patients** rest exercise p ST-dep.< 1mm ST-dep.≥ 1mm baseline 52.7 55.4 ns 0 21 placebo 53.2 56.1 ns .1 17 amlodipine 55.6 56.5 ns 10 11 * No differences were seen in LVEF within the treatment periods. **Amlodipine reduced the number of patients with ST-depressions compared to baseline and placebo (p<0.001). No difference was seen from baseline to placebo. (Mean: ST depressions: baseline 1.9 mm, placebo 1,6 mm, amlodipine 0,7 mm). Conclusion: Amlodipine reduced myocardial ischaemia effectively in patients with SI, as shown by reductions in electrocardiographic ST-depressions. This without inducing negative inotropy. even during exercise. Thus, amlodipine seems to be a safe anti-ischaemic drug without any negative influence on left ventricular systolic function in patients with silent ischaemia.