Effects of titrated beta blockade (metoprolol) on silent myocardial ischemia in ambulatory patients with coronary artery disease

Imperi, Greg A.; Lambert, Charles R.; Coy, Kevin; Lopez, Larry M.; Pepine, Carl J.

doi:10.1016/0002-9149(87)90297-9

Cited by 142 publications

(13 citation statements)

References 19 publications

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“…This circadian tendency of myocardial ischemia was reported in several studies that repeatedly demonstrated a higher number of episodes and longer time of ischemia during wakefulness, especially in the morning. Some investigators also reported a bimodal behavior with the presence of another ischemic peak at the beginning of the night, which is consistent with our findings 8,13,[22][23][24] . In relation to BP monitoring, we verified that both ischemic and non-ischemic patients maintained their SBP, DBP and MBP controlled in the 24 hours and in the active and passive periods, like in Rehman et al's study 20 in a population similar to ours.…”

Section: Graphic 1 -Number and Duration Of Ischemic Episodes By 4-housupporting

confidence: 93%

Isquemia silenciosa na doença coronariana estável em vigência de tratamento medicamentoso

Ferreira¹,

César²,

Gruppi³

et al. 2007

Arq. Bras. Cardiol.

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Section: Graphic 1 -Number and Duration Of Ischemic Episodes By 4-housupporting

confidence: 93%

Isquemia silenciosa na doença coronariana estável em vigência de tratamento medicamentoso

Ferreira¹,

César²,

Gruppi³

et al. 2007

Arq. Bras. Cardiol.

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“…It has been suggested that betablockade could blunt the beta-adrenergic mediated in crease in heart rate, thus reducing duration and magni tude of ischemic episodes [16]. Analysis of heart rate variables in this study support this conclusion.…”

Section: Discussionsupporting

confidence: 75%

“…Furthermore, it has been observed that most ischemic episodes are not preceded by an increase in heart rate, the major determinant of myocar tion or reduction of total ischemic activity and not only symptomatic episodes. Traditionally, beta-adrenoceptor blocking agents, which reduce myocardial oxygen de mand, are recommended in effort-induced angina, and calcium antagonists and nitrates, which influence myo cardial oxygen supply, are preferred in mixed angina or angina at rest [9][10][11][12], The informations relative to treat ment of silent ischemia are limited to patients with effort angina [13], nocturnal or angina at rest [14,15] and small numbers of mildly symptomatic patients or with mixed angina [16,17]. .A comparison of pharmacologic agents that has effect on either myocardial oxygen de mand or supply have not previously been investigated in effort-induced angina and mixed angina.…”

Section: Introductionmentioning

confidence: 99%

Effects of Metoprolol, Nifedipine and Their Combination on Total Ischemic Activity in Effort and Mixed Angina

Egstrup¹

1989

Am J Noninvas Cardiol

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In a randomized double-blind study the effect of metoprolol, nifedipine and their combined therapy were investigated on total ischemic activity detected by ambulatory monitoring. The study was performed in 2 groups of patients, who were defined by clinical history as classical effort-induced angina (group 1 ; n = 16) and mixed angina (group 2; n = 25) to assess possible differences in pathophysiology and guidelines to therapy. In group 1, metoprolol significantly reduced the frequency of total and silent ischemic episodes (77 and 71 % respectively, p < 0.05) and reduced the durations of total and silent ischemia (73 and 61 %, respectively; p < 0.05). Nifedipine was without any statistically significant effect. The combined therapy reduced total ischemic events (77%; p < 0.05), silent ischemia (76%; p < 0.05) and durations of total and silent ischemia (78 and 71 %, respectively; p < 0.05). In group 2 there was a trend toward a reduction in the frequency of total ischemia, silent ischemia and duration of ischemia during therapy with metoprolol (36, 33 and 32%, respectively; NS). In contrast, an insignificant increase in total ischemia, asymptomatic ischemia and duration of asymptomatic ischemia was noted during nifedipine therapy (24, 35 and 8%, respectively; NS). Combination therapy significantly reduced total ischemic episodes, silent episodes and duration of ischemia (59, 65 and 67%; p < 0.05). Assessment of heart rate at onset of ischemia during daily life and during exercise testing indicate reductions in myocardial oxygen supply as a major determinant for transient myocardial ischemia out of hospital in both effort and mixed angina, and no differences in pathogenetic mechanisms between the 2 groups of patients could be observed. Therefore, the division into effort-induced angina and mixed angina seems arbitrary and gave no guideline to a specific therapy as metoprolol monotherapy and combined therapy of metoprolol and nifedipine were preferable in both groups.

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“…Since severe and extensive myocardial hypoperfusion is associated with a high risk of future cardiac events, 3233 patients with this finding should undergo coronary angiography, which can be combined safely with carotid angiography. 34 Patients with severe multivessel or left main disease should be considered for CABG, 30 -31 whereas patients with less extensive disease should be treated with /3-blockers or calcium channel blockers 35 " 37 or angioplasty. 38 The results of ongoing studies comparing medical therapies for silent myocardial ischemia 22 ' 39 should be incorporated into this protocol as they become available.…”

Section: Discussionmentioning

confidence: 99%

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Chimowitz

Weiss

Cohen

et al. 1994

Stroke

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Patients with carotid stenosis have a high frequency of asymptomatic coronary artery disease (CAD). The purpose of this study of patients with asymptomatic carotid stenosis was to test the hypothesis that patients without a history of CAD have the same cardiac prognosis as patients with a history of CAD. Men enrolled in the Department of Veterans Affairs study on the efficacy of carotid endarterectomy for asymptomatic carotid stenosis underwent a baseline cardiac evaluation (history, physical examination, and electrocardiogram) to document previous angina or myocardial infarction. Patients were randomized to medical therapy alone or medical therapy and carotid endarterectomy. Medical therapy consisted of aspirin 650 mg twice daily and treatment of risk factors. All episodes of angina, myocardial infarction, or sudden death during follow-up (average of 47.9 months) were recorded. Of 444 men enrolled in the study, 200 (45%) had a history of CAD. During the study 86 (43%) of 200 patients with CAD and 81 (33%) of 244 patients without a history of CAD had cardiac ischemic events (P = .03). In patients without a history of CAD, the first cardiac event was myocardial infarction or sudden death in 45 patients (56%). Factors that were independently associated with cardiac events in patients without a history of CAD were diabetes (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.15 to 3.97), intracranial occlusive disease (OR, 2.13; 95% CI, 1.13 to 4.02), and peripheral vascular disease (OR, 2.04; 95% CI, 1.14 to 3.66). Forty-two percent of patients with two of these factors and 69% of patients with all three factors had cardiac events. Men with carotid stenosis and no history of CAD have a lower rate of cardiac events than men with carotid stenosis who have a history of CAD. However, a subgroup of patients with carotid stenosis and no history of CAD who have coexistent intracranial occlusive disease, diabetes, or peripheral vascular disease have a risk of cardiac events similar to that of patients with a history of CAD.

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Effects of titrated beta blockade (metoprolol) on silent myocardial ischemia in ambulatory patients with coronary artery disease

Cited by 142 publications

References 19 publications

Isquemia silenciosa na doença coronariana estável em vigência de tratamento medicamentoso

Isquemia silenciosa na doença coronariana estável em vigência de tratamento medicamentoso

Effects of Metoprolol, Nifedipine and Their Combination on Total Ischemic Activity in Effort and Mixed Angina

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

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