Coronary haemodynamic effects of short-term intravenous administration of gallopamil in patients with stable exertional angina.

Servi, Stefano De; Ferrario, Maurizio; Ghio, Stefano; Antonio, Martín; L, Angoli; Bramucci, Ezio; Bartoli, Antonella; Poma, E.; Rondanelli, R; Specchia, Giuśeppe

doi:10.1136/hrt.57.3.226

Cited by 14 publications

(2 citation statements)

References 14 publications

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“…[ 11] provided further infor mation for the importance of the reduction in the myocardial oxygen demand: during atrial pacing, after acute gallopamil administration, pacing tolerance was increased, but no varia tions were observed in mean blood flow in the great cardiac vein or in regional coronary resistance.…”

Section: Discussionmentioning

confidence: 99%

Gallopamil in Chronic Stable Angina: Antianginal Effect and Mechanism of Action

Zanolla¹,

Carbonieri²,

Rossi³

et al. 1992

Cardiology

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A double-blind, placebo-controlled, cross-over trial of oral gallopamil was performed in 10 patients with stable angina. Gallopamil significantly increased mean exercise time and 1-mm ST time. The rate-pressure product was increased at 1 -mm ST time, but unmodified at the highest comparable work load and at peak exercise. The ST segment depression was significantly reduced both at the highest comparable work load and at peak exercise. Gallopamil proves safe and effective; the mechanism of its anti-ischemic effect seems to be due both to an increase in myocardial oxygen supply and to a reduction in myocardial oxygen demand.

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Section: Discussionmentioning

confidence: 99%

Gallopamil in Chronic Stable Angina: Antianginal Effect and Mechanism of Action

Zanolla¹,

Carbonieri²,

Rossi³

et al. 1992

Cardiology

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“…17-22]. reduces peripheral arterial resistance, cardiac work and oxygen consumption [23][24][25][26]. In addition, gal lopamil dilates the epicardial coronary artery [27,28], decreases the excitability of the sinus node, delays atrio ventricular conduction (17,29], leads to a prolongation of the diastole and thus improves total myocardial perfusion [30].…”

Section: Discussionmentioning

confidence: 99%

Effect of Gallopamil on Myocardial Microperfusion in Patients with Stable Effort Angina: A Randomized, Cross-Over, Double-Blind, Placebo-Controlled Trial

et al. 1997

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We evaluated the efficacy and safety of daily administration of gallopamil 150 mg/day and its effects on myocardial perfusion in a medium-term, randomized, double-blind, cross-over, placebo-controlled trial. We studied 19 patients (17 males and 2 females; mean age 57 ± 6.8 years) with stable effort angina, angiographically documented coronary artery disease and reversible perfusion defects during exercise thallium-201 myocardial scintigraphy of at least one segment of the left ventricle. After 2 weeks of a single-blind placebo run-in period, during which each patient underwent at least 2 exercise tests and a 48-hour Holter ECG recording, all patients were treated with either placebo or gallopamil 50 mg t.i.d. for 28 days. At the end of this period, patients crossed over to the alternate regimen. This phase was double blind. After treatment with placebo or gallopamil, patients underwent exercise tests, 24-hour Holter ECG recording and thallium-201 myocardial scintigraphy. Weekly angina frequency and trinitroglycerin (TNT) consumption and safety were also evaluated. No patients dropped out of the study because of major side effects. The number of total ischemic and symptomatic events recorded at 24-hour ECG monitoring, weekly angina frequency and TNT consumption were significantly reduced during gallopamil treatment. After gallopamil administration, exercise duration significantly increased (run-in: 419 ± 116 s, placebo: 420 ± 118 s, gallopamil: 511 ± 144 s; p < 0.05), and ST segment depression was significantly reduced (run-in: -1.3 ± 0.3 mm, placebo: -1.3 ± 0.3 mm, gallopamil: -0.94 ± 0.68 mm; p < 0.01), while heart rate, systolic blood pressure and rate-pressure product were unchanged at rest, at submaximal and at peak exercise. Qualitative and quantitative evaluation of myocardial perfusion and the myocardial uptake percentage of thallium-201 in ischemic zones were significantly improved by gallopamil treatment. These findings demonstrate that gallopamil can improve myocardial perfusion and reduce myocardial oxygen consumption.

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Comparison of the potassium channel blocker tedisamil with the beta‐adrenoceptor blocker esmolol and the calcium antagonist gallopamil in patients with coronary artery disease

Mitrović

Oehm

Thormann

et al. 1998

Clinical Cardiology

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Background: Tedisamil is a new bradycardic agent proven to exert anti‐ischemic and antiarrhythmic effects by blockade of the different cardiac and vascular K+ currents. Hypothesis: It was the aim of the present study to compare the favorable anti‐ischemic effects of tedisamil, with two long established representatives in the treatment of coronary artery disease (CAD), namely, the beta1 blocker esmolol and the Ca2 antagonist gallopamil. Methods: The hemodynamic and neurohumoral effects of the new potassium channel blocker tedisamil, an agent with negative chronotropic and class III antiarrhythmic properties, were compared with the ultra‐short‐acting beta1‐selective adrenoceptor blocker esmolol and the calcium antagonist gallopamil. A total of 22 patients with angiographically proven CAD and reproducible ST‐segment depression in the exercise electrocardiogram was included in two studies with an almost identical design and inclusion criteria. The investigation was carried out using right heart catheterization and bicycle ergometry. A subgroup of 8 patients receiving 0.3 mg/kg body weight tedisamil intravenously (IV) in an open dose‐finding study was compared with a group of 14 patients who had received esmolol (IV bolus of 500 μg/kg, maintenance dose 200 μg/kg/min) and gallopamil (initial dose 0.025 mg/kg, maintenance dose 0.0005 mg/kg/h) in a second intraindividual comparison. Results: Tedisamil and esmolol reduced heart rate at rest by 13% (p < 0.001), and 6% (p < 0.05), and at maximum working levels by 8% (p>0.01) and 9% (p>0.05), respectively. Gallopamil increased heart rate at rest by 7% (p < 0.05), with only slight changes occurring during exercise. Corresponding findings for each drug were observed for cardiac output both at rest and during exercise [tedisamil: at rest ‐10% (NS), max. exercise ‐ 8%; esmolol: at rest ‐14% (NS), max. exercise ‐18% (NS); gallopamil: no significant changes]. Compared with tedisamil, stroke volume was reduced by esmolol [at rest and max. workload: ‐9% (NS)] and gallopamil [rest: ‐6% (NS), max. exercise: ‐2% (NS)]. Of the indirect parameters of ventricular function, that is, mean capillary wedge pressure (PCWPm) and right ventricular ejection fraction, only PCWPm demonstrated significant differences between tedisamil and gallopamil (+18% and ‐6% at rest, + 17% and ‐21% during exercise, respectively; p>0.001). Compared with gallopamil, both tedisamil and esmolol were superior in their effects on rate‐pressure product, myocardial oxygen consumption, and ST‐segment depression, whereas plasma lactate concentration was more reduced by tedisamil and gallopamil. Tedisamil led to a fall in norepinephrine levels in particular. Conclusion: Tedisamil and esmolol showed almost equipotent anti‐ischemic effects at the doses administered. Tedisamil acts mainly by reductions in heart rate, and esmolol, though to a lesser degree, also by reductions in systolic blood pressure. The mechanism of gallopamil is to reduce afterload and to improve coronary perfusion. At the doses applied, however...

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Coronary haemodynamic effects of short-term intravenous administration of gallopamil in patients with stable exertional angina.

Cited by 14 publications

References 14 publications

Gallopamil in Chronic Stable Angina: Antianginal Effect and Mechanism of Action

Gallopamil in Chronic Stable Angina: Antianginal Effect and Mechanism of Action

Effect of Gallopamil on Myocardial Microperfusion in Patients with Stable Effort Angina: A Randomized, Cross-Over, Double-Blind, Placebo-Controlled Trial

Comparison of the potassium channel blocker tedisamil with the beta‐adrenoceptor blocker esmolol and the calcium antagonist gallopamil in patients with coronary artery disease

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