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.
|Tidsskrift||Scandinavian Cardiovascular Journal, Supplement|
|Status||Udgivet - 1 dec. 1997|