Effects of nicardipine on exercise- and pacing-induced myocardial ischemia in angina pectoris |
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| Authors: | C R Lambert J A Hill R L Feldman C J Pepine |
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| Affiliation: | 1. From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA;2. From the Veterans Administration Medical Center, Gainesville, Florida, USA;1. Department of Civil Engineering, University of Sherbrooke, Quebec J1K 2R1, Canada;2. Department of Civil and Building Engineering, University of Sherbrooke, Quebec, Canada;3. Faculty of Engineering at Shoubra, Benha University, Egypt;4. Department of Civil and Building Engineering, University of Sherbrooke, Quebec, Canada;5. B&B FRP Manufacturing Inc., Ryerson University, Ontario, Canada;1. State Key Laboratory of Catalysis, Dalian Institute of Chemical Physics, Chinese Academy of Sciences,457 Zhongshan Road, Dalian 116023, China;2. University of Chinese Academy of Sciences, Beijing 100049, China;1. Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL 33146, USA;2. College of Transportation and Civil Engineering, Fujian Agriculture and Forestry University, Fuzhou, 350108, China;3. Civil and Construction Engineering, Oregon State University, Corvallis, OR 97331, USA;1. Politecnico di Milano, Dipartimento di Energia, Via Lambruschini, 4A, 20156 Milano, Italy;2. Ing. Enea Mattei S.p.a., Strada Padana Superiore, 307, 20090 Vimodrone, Milano, Italy;3. Valenti Energie S.r.l., Res. Mestieri Milano Due, 20090 Segrate, Milano, Italy |
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| Abstract: | To define the effects of nicardipine, a new dihydropyridine calcium antagonist drug, on exercise- and pacing-induced myocardial ischemia, 15 men with coronary artery disease were studied during cardiac catheterization. Nicardipine was administered intravenously as a 2-mg bolus followed by an infusion titrated to maintain a 10- to 20-mm Hg decrease in systolic arterial pressure. At rest, nicardipine decreased systemic and coronary vascular resistances, left ventricular end-diastolic pressure and increased coronary blood flow, heart rate and myocardial oxygen consumption. During bicycle exercise-induced myocardial ischemia, nicardipine significantly prolonged exercise duration and time to 1 mm of ST-segment depression. These changes were associated with no alteration in the product of systolic pressure and heart rate, decreased left ventricular end-diastolic pressure, systemic and coronary vascular resistances and increased coronary blood flow, as well as myocardial oxygen consumption. During atrial pacing, the heart rate threshold for myocardial ischemia was not changed by nicardipine administration, despite improvement in the ratio of coronary blood flow to myocardial oxygen consumption and hemodynamic changes otherwise similar to those during exercise. Nicardipine favorably influenced myocardial metabolic state, as indexed by lactate extraction during pacing-induced ischemia. Nicardipine is a potent coronary and systemic vasodilating drug that improves exercise tolerance and myocardial metabolic response to pacing stress, the mechanism for which appears to be partially mediated through increased coronary blood flow. |
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