From the Cardiology Department, University Hospital of Wales, Cardiff,
South Wales (C.A.R., A.Z.L., N.D.M., P.G.A., E.J.); and Cardiology, Royal
Postgraduate Medical School, London, UK (C.A.R., R.J.C.H.).
Correspondence to Dr Christopher A. Rinaldi, Cardiology Department, Medway Hospital, Gillingham, Kent ME7 5NY, United Kingdom. E-mail c.a.rinaldi{at}btinternet.com
Background—Myocardial stunning may
cause prolonged left ventricular dysfunction after
exercise-induced ischemia that can be attenuated by calcium
antagonists in animal models. To assess their effects in
humans, we performed a randomized, double-blind crossover study
comparing the calcium antagonist amlodipine (10 mg once
daily) versus isosorbide mononitrate (ISMN, 50 mg once daily) on
postexercise stunning.
Methods and Results—Twenty-four men with chronic stable angina
and normal left ventricular function underwent serial
quantitative exercise stress echocardiography after
3 weeks on each treatment to assess the degree of postexercise stunning
with simultaneous sestamibi single-photon emission computed
tomography perfusion scans at peak stress to quantify the
ischemic burden. Exercise time (P=1), maximum ST
depression (P=0.48), and sestamibi single-photon
emission computed tomography scores (P=0.17) were
unchanged between treatments. Stunning occurred more often with ISMN
than amlodipine (82% versus 48%). The global and segmental stress
echocardiography parameters of stunning
were attenuated in patients while taking amlodipine compared with ISMN.
Shortening fractions and ejection fractions were less impaired 30
minutes after exercise in patients receiving amlodipine (3.5±1.4%
versus 2.5±1.4%, P=0.014, and 59.7±5.4% versus
54.5±8%, P<0.001); similarly, the isovolumic
relaxation period was less prolonged with amlodipine (93±15.5 versus
106.3±14.9 ms, P=0.018).
Conclusions—Despite comparable levels of ischemia,
amlodipine attenuated stunning when compared with ISMN. This beneficial
effect may relate to a prevention of the calcium overload implicated in
the pathogenesis of stunning.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Randomized, Double-Blind Crossover Study to Investigate the Effects of Amlodipine and Isosorbide Mononitrate on the Time Course and Severity of Exercise-Induced Myocardial Stunning
Key Words: stunning, myocardial • calcium channels • echocardiography • exercise
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