Exercise-induced symptomatic and asymptomatic myocardial ischemia in patients with severe coronary artery disease: focus on the efficacy and safety of gallopamil.

Abstract

Symptomatic and asymptomatic episodes of transient myocardial ischemia are well-known risk factors in patients with coronary artery disease. In a single-blind, randomized, and placebo-controlled study, the efficacy and safety of gallopamil was studied during a 1-week treatment period in 25 patients with high-grade coronary artery stenosis and frequent, exercise-induced episodes of myocardial ischemia. Eighteen patients were men, and seven patients were women; the mean age +/- SD was 59 +/- 7 years. After a 1-week run-in period (days 1-7), all patients were treated with gallopamil 50 mg t.i.d. (days 8-14) and placebo t.i.d. (days 15-21) or vice versa. Twenty-four-hour Holter monitoring, exercise testing, and adverse effects were controlled at days 7, 14, and 21. During the run-in period, all patients suffered a mean of 5.9 +/- 2.9 episodes of transient myocardial ischemia, mean ischemic duration was 38 +/- 29 min/day. Gallopamil increased exercise tolerance from 7.9 to 9.8 min (+24%, p < 0.05) and resulted in reduction of the weekly usage of short-acting nitrates by 45% compared to placebo. During 24-h Holter monitoring, mean heart rate at the onset of ST-segment depression increased from 106 to 118 beats/min (p < 0.05). The frequency of daily ischemic episodes was reduced after gallopamil administration from 6.1 to 3.9 episodes/day (-37%, p < 0.05), the total ischemic burden decreased for symptomatic episodes by -54% (p < 0.05) and for asymptomatic episodes by 29% (p < 0.05). Gallopamil modified the circadian distribution of ischemic episodes by modifying the morning peak of transient myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

• Authors: M Zehender, U Kosscheck, S Hohnloser, C Weiss, T Meinertz, H Just
• Journal: Journal of cardiovascular pharmacology (J Cardiovasc Pharmacol) Vol. 20 Suppl 7 Pg. S57-63 ( 1992) ISSN: 0160-2446 [Print] United States
• PMID: 1284158 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Gallopamil

Topics

• Aged
• Arrhythmias, Cardiac (prevention & control)
• Circadian Rhythm (drug effects)
• Coronary Disease (drug therapy, etiology, physiopathology)
• Electrocardiography
• Electrocardiography, Ambulatory
• Exercise
• Exercise Test
• Female
• Gallopamil (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged