Advertisement

Effect of nifedipine on exercise-induced left ventricular dysfunction and myocardial hypoperfusion in stable angina

  • Nadim M. Zacca
    Correspondence
    Address for reprints: Nadim M. Zacca, MD, Cardiac Catheterization Laboratories (111B), 2002 Holcombe Boulevard, Houston, Texas 77211.
    Affiliations
    From the Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

    From the Veterans Administration Medical Center, Houston, Texas, USA
    Search for articles by this author
  • Mario S. Verani
    Affiliations
    From the Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

    From the Veterans Administration Medical Center, Houston, Texas, USA
    Search for articles by this author
  • Robert A. Chahine
    Affiliations
    From the Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

    From the Veterans Administration Medical Center, Houston, Texas, USA
    Search for articles by this author
  • Richard R. Miller
    Affiliations
    From the Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

    From the Veterans Administration Medical Center, Houston, Texas, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      To assess the effects of nifedipine on left ventricular function and regional myocardial perfusion, exercise radionuclide ventriculography was performed in 15 men (median age 59 years) and exercise thallium-201 scintigraphy was done in 11 of them, before and 90 minutes after the oral administration of 20 mg of nifedipine. All patients had stable angina and angiographically proved coronary artery disease without evidence of spasm. Exercise tolerance after administration of nifedipine increased from 343 ± 42 seconds to 471 ± 50 seconds (p < 0.01), whereas the peak exercise double product remained essentially unchanged (difference not significant). Ejection fraction improved significantly at rest (from 49 ± 3.6% to 52 ± 3.3%, p < 0.05) and at peak exercise (42 ± 3.3% to 47 ± 3.7%, p < 0.05). Nifedipine also resulted in an improved segmental wall motion score (4.3 ± 2.3 to 3.0 ± 2.3, p < 0.05; 0 = normal and 4 = worst degree of dysfunction). The ejection fraction increased by more than 5% in one third of the patients at rest, and in more than half of the patients at peak exercise. Improved exercise myocardial perfusion occurred in 5 of 11 patients (45%) and in 7 of 28 segments (25%) with reversible hypoperfusion. Thus, nifedipine produces significant improvement in global and regional left ventricular function in patients with coronary artery disease and stable angina. This may be accounted for, at least in part, by improvement in myocardial perfusion.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vater W
        • Kronenberg G
        • Hoffmeister F
        • et al.
        Pharmacology of 4-(2-nitro-phenyl)-2,6-dimethyl-1,4-dihydropyridine-3, 5-dicarboxylic acid dimethylester (nifedipine, Bay a 1040).
        (Ger) Arzneimittelforsch. 1972; 22: 1-14
        • Kircheim H
        • Gross R
        Hemodynamic effects of Adalat® in the unanesthesized dog.
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 82-91
        • Vauden Braund M
        • Reeme WJ
        • Maesler GT
        • Tiggelaar-de Widt I
        • de Ruiter R
        • Hugenboltz PG
        Changes in left and right ventricular hemodynamics in angina pectoris patients following Adalat® administration.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 69-75
        • Fleckenstein A
        Specific pharmacology of calcium in myocardium, cardiac pacemakers, and vascular smooth muscle.
        Ann Rev Pharmacol Toxicol. 1977; 17: 149-166
        • Hosoda S
        • Kimura E
        Efficacy of nifedipine in the variant form of angina pectoris.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 195-199
        • Muller JE
        • Gunther SJ
        Nifedipine therapy for Prinzmetal's angina.
        Circulation. 1978; 67: 137-139
        • Folle LE
        • Oritz A
        • Artucio R
        • Dighiero J
        Efficacy of Adalat® in angina pectoris patients in controlled clinical trial compared with placebo.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 200-206
        • Menna J
        • Trainer M
        • Ferreiros E
        • Cassera JC
        Long-term double-blind cross-over study on the antianginal efficacy of Adalat® compared with placebo.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 277-279
        • Moskowitz RM
        • Piccini PA
        • Nacarelli GU
        • Zelis R
        Nifedipine therapy for stable angina pectoris: preliminary results of effects of angina frequency and treadmill exercise response.
        Am J Cardiol. 1979; 44: 811-816
        • Mueller HS
        • Chahine RA
        Interim report of multicenter double-blind, placebo-controlled studies of nifedipine in chronic stable angina. Symposium on nifedipine in angina pectoris.
        Am J Med. 1981; 71: 645-657
        • Landmark K
        • Refsum H
        The effect of Adalat on the mechanical and electrical activity of isolated rat cardiac muscle, with special reference to calcium antagonism of the compound.
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 101-110
        • Palese A
        • Fiorentini C
        • Olivari MT
        • Guazzi M
        Clinical use of a calcium antagonistic agent (nifedipine) in acute pulmonary edema.
        Am J Med. 1979; 66: 825-830
        • Gillmer DJ
        • Kark P
        Pulmonary oedema precipitated by nifedipine.
        Br Med J. 1980; 280: 1420-1421
        • Klugmann S
        • Salvi A
        • Camerini F
        Haemodynamic effects of nifedipine in heart failure.
        Br Heart J. 1980; 43: 440-446
        • Horster FA
        Pharmacokinetics of Nifedipine-14C in Man.
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 124-127
        • Pavel DG
        • Zimmer AM
        • Patterson VN
        In vivo labeling of red blood cells with Tc-99m: a new approach to blood pool visualization.
        J Nucl Med. 1976; 17: 216-232
        • Burow RD
        • Strauss HW
        • Singleton R
        • et al.
        Analysis of left ventricular function from multiple gated acquisition cardiac blood pool imaging: comparison to contrast angiography.
        Circulation. 1977; 56: 1024-1028
        • Verani MS
        • Hartung HG
        • Harris JG
        • Welton DE
        • Pratt CM
        • Miller RR
        Effects of exercise training on left ventricular performance and myocardial perfusion in patients with coronary artery disease.
        Am J Cardiol. 1981; 47: 797-803
        • Verani MS
        • Jhingran S
        • Attar M
        • Rizk A
        • Quinones MA
        • Miller RR
        Post-stress redistribution of thallium-201 in patients with coronary artery disease, with and without prior myocardial infarction.
        Am J Cardiol. 1979; 43: 1114-1122
        • Ekelund LG
        • Oro L
        Antianginal efficiency of nifedipine with and without a beta-blocker, studied with exercise test. A double blind-randomized subacute study.
        Clin Cardiol. 1979; 2: 203-211
        • Ekelund LG
        • Atterhog JH
        • Melin AL
        Effect of nifedipine on exercise tolerance in patients with angina pectoris.
        in: Hashimoto K Kinura E Kobayarski T New Therapy of Ischemic Heart Disease. Proceedings of the First International Adalat® Symposium. University of Tokyo Press, Tokyo1973: 144-149
        • Mcllwraith G
        Adalat (nifedipine) under loading conditions.
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 174-177
        • Prempree A
        • Tabtznik B
        Influence of different doses of nifedipine on angina pectoris induced by exercise.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 113-118
        • Ebner F
        Survey and summary of results obtained during the world-wide clinical investigations of Adalat® (nifedipine).
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 348-359
        • Kimura E
        • Mabuchi G
        • Kikuchi HU
        The clinical effect of 4-(2'-Nitrophenyl)-2,6-dimethyl-3, 5-dicarbomethoxy-1, 4-dihydropyridine on angina pectoris. Evaluated by sequential analysis.
        Arzneimittelforsch. 1972; 22: 365-367
        • Camerini F
        • Angelino PF
        • Bobba P
        • Caturelli G
        • Cherchi A
        • Maggi GC
        Nifedipine in angina pectoris—a multicentric clinical trial.
        G Ital Cardiol. 1974; 4: 575-582
        • Maggi GC
        Clinical observation on the efficacy of nifedipine versus timed disintegration capsules of pentaerythrityl tetranitrate.
        Circulation. 1977; 56: 160-162
        • Maggi GC
        • Piscitello F
        Clinical observations on the efficacy of Adalat compared with a pentaerythrityl tetranitrate preparation.
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 281-284
        • Sakuma A
        • Kimura E
        An interim report on a cooperative double-blind clinical trial with nifedipine.
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 329-332
        • Hirakawa S
        • Ito H
        • Kondo Y
        • Watanabe I
        • Hiei K
        • Banno S
        • Hayase S
        Coronary circulation, systemic resistance and capacitance blood vessels of dogs as affected by BAY a 1040.
        Arzneimittelforsch. 1972; 22: 344-349
        • White SW
        • Proges WL
        • McRitchie RJ
        Coronary hemodynamic effects of nifedipine and glyceryl trinitrate in unanesthetized dogs.
        Clin Exp Pharmacol Physiol. 1974; 1: 77-86
        • van den Brand M
        • Ramme WJ
        • Meester GR
        • Tiggelaar-deWidt I
        • deRuiter R
        • Hugenholtz RG
        Changes in left and right ventricular hemodynamics in angina pectoris patients following Adalat administration.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 69-75
        • Vater W
        • Schlossman K
        Effects of nifedipine on hemodynamics and the oxygen consumption of the heart in animal experiments.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 33-41
        • Kirchheim H
        • Gross R
        Hemodynamic effects of Adalat in the unanesthetized dog.
        in: Locher W Braasch W Kroneberg G New Therapy of Ischemic Heart Disease. Proceedings of the Second International Adalat® Symposium. Springer-Verlag, Berlin1975: 82-90
        • Lichtlen P
        • Engel HJ
        • Amende I
        • Rafflenbeul W
        • Simon R
        Mechanism of various antianginal drugs. Relationship between regional flow behavior and contractility.
        in: Jatene AD Lichtlen PR New Therapy of Ischemic Heart Disease. Proceedings of the Third International Adalat® Symposium. Excerpta Medica, Amsterdam1976: 14-29
        • Lichtlen PR
        • Engel HJ
        • Wolf R
        • Pretschner P
        Regional myocardial blood flow in patients with coronary artery disease after nifedipine.
        in: Lichtlen PR Kimura E Taira N New Experimental and Clinical Results, International Adalat® Panel Discussion. Excerpta Medica, Amsterdam1979: 69-85