Lack of diurnal variation in maximal symptom-limited exercise test response in chronic stable angina

Khurmi, Nardev S.; Raftery, Edward B.

doi:10.1016/0002-9149(88)91300-8

Cited by 15 publications

(4 citation statements)

References 30 publications

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“…Unlike Thadani's study [26], but simi larly to Wortmann et al [18,19], our study was open and not placebo-controlled, for ethical reasons. This design is satisfactory as it has been previously shown by Khurmi and Raftery [27] that placebo has no effect on hemodynamics or exercise tolerance.…”

Section: Discussionmentioning

confidence: 74%

Slow Release Isosorbide-5-Mononitrate Therapy in Angina Pectoris

Jansen¹,

Prenzel²,

Rappert³

et al. 1991

Cardiology

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The possibility of maintaining preload reduction and enhancement of exercise tolerance during an interval treatment with 100 mg/day of slow-release isosorbide-5-mononitrate (IS-5-MN) was investigated in 12 patients (aged 57 ± 5.0 years) with angiographically confirmed coronary artery disease and chronic stable angina pectoris. The effects of a single dose (acute test) were compared with those following an 8-day (chronic) regimen of mononitrate administration. Two hours after administration of 100 mg sustained-release IS-5-MN, mean resting pulmonary artery pressure (PAP), measured with a Swan-Ganz catheter, was reduced by 32% (p < 0.001) and at submaximal exercise level (50 W, 3 min) by 37% (p < 0.001). At individually highest comparable work loads mean PAP was reduced by 37% (p < 0.001), and at maximal work load the PAP reduction was 14% (p < 0.05). At the end of 1 week of therapy with sustained-release IS-5-MN a slight, clinically irrelevant reduction of hemodynamic effects was recorded. Work capacity increased after 1 h by 79% (264 ± 154 vs. 472 ± 180 W × min, p < 0.01), still significantly above base-line 10 h after nitrate administration. No difference from baseline was demonstrable 24 h after medication. During interval therapy the improved work capacity was fully maintained (chronic, 1 h: 280 ± 119 vs. 532 ± 160 W × min, p < 0.001). There was no significant difference between the plasma IS-5-MN levels at acute and chronic therapy. During interval therapy with sustained-release IS-5-MN, hemodynamics and exercise tolerance were durably improved. Thus, the once-daily intake is beneficial for patient compliance and prevents tolerance development during long-term therapy of coronary artery disease.

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Section: Discussionmentioning

confidence: 74%

Slow Release Isosorbide-5-Mononitrate Therapy in Angina Pectoris

Jansen¹,

Prenzel²,

Rappert³

et al. 1991

Cardiology

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“…The observed circadian rhythm in the exercise-induced ST-segment depression (Placebo: average morning values 8.93, 6.98 and 8.71 mm; average afternoon values 11.35 and 10.44 nun) is not consistently found in patients with coronary heart disease [15], and its occurrence might depend on the type of protocol used and the timing of the exercise tests.…”

Section: Discussionmentioning

confidence: 92%

24-hour anti-ischaemic action with once daily nifedipine

Woodcock

Thürmann

Pfleiderer

et al. 1992

Eur J Clin Pharmacol

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The ability of a fatty-alcohol matrix, slow-release tablet of nifedipine 60 mg to maintain a 24-hour anti-ischaemic action in the fixed dose of 60 mg once daily has been investigated in a randomised, placebo-controlled, double-blind trial. 12 normotensive patients with angiographically proven coronary artery disease (stenosis of at least one major vessel > or = 70%) were studied. The anti-ischaemic response was assessed over a period of 4 days as changes in the exercise-induced ST-segment depression 6 h and 24 h post-dose, and ST-segment changes in 24-h ambulatory ECGs. A measurable anti-ischaemic response was observed in 8 of the 12 patients. Exercise-induced ST-segment depression 6 h after the administration of nifedipine was reduced by 30% compared to placebo, and there was still a measurable anti-ischaemic response 24-h post-dosing. Both responses were independent of changes in exercise blood pressure. In 7 patients with ischaemic episodes in the 24-h ECGs, nifedipine treatment had only a minor effect on the intensity and duration of ischaemia. It is concluded that a significant anti-ischaemic effect lasting 24 h could be demonstrated using effort-induced ST-segment changes in patients with angiographically proven coronary heart disease, who were treated once daily with nifedipine 60 mg as a fatty-alcohol slow release tablet.

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“…The radiotelemetric data transfer en-sured the least possible disturbance of the circadian rhythm while relying on invasive hemodynamic parameters for maximal accuracy. With noninvasive parameters, such as exercise duration and time-to-angina, it is difficult to record significant changes in exercise response ( 13).…”

Section: Discussionmentioning

confidence: 99%

Chronotherapy in Coronary Heart Disease: Comparison of Two Nitrate Treatments

Wortmann¹,

Bachmann²

1991

Chronobiology International

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The purpose of this study was to assess the ischemic burden and the hemodynamic changes during daily activities in patients with coronary heart disease. Three exercise tests were performed during the day (10:00 a.m., 2:00 p.m., 6:00 p.m.), recording ST-segment depression, pulmonary artery pressure, pulmonary wedge pressure, and cardiac output as well as heart rate and systemic blood pressure during placebo and nitrate therapy. With placebo as well as nitrate therapy there was a gradual increase of ischemia and preload and a decrease of cardiac output during the day. High nitrate concentrations led to a significant reduction of both preload and ST depression with a marked circadian phase dependency of cardiovascular effects.

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Lack of diurnal variation in maximal symptom-limited exercise test response in chronic stable angina

Cited by 15 publications

References 30 publications

Slow Release Isosorbide-5-Mononitrate Therapy in Angina Pectoris

Slow Release Isosorbide-5-Mononitrate Therapy in Angina Pectoris

24-hour anti-ischaemic action with once daily nifedipine

Chronotherapy in Coronary Heart Disease: Comparison of Two Nitrate Treatments

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