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Cited by 26Cardiac Imaging and DiagnosticsCoronary Interventions and DiagnosticsCardiovascular and exercise physiology

Coronary vasomotion during dynamic exercise: Influence of intravenous and intracoronary nicardipine

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Kaufmann, Philipp, Vassalli, Giuseppe, Utzinger, URS, Hess, Otto M.·1995·Journal of the American College of Cardiology
DOI 10.1016/0735-1097(95)00247-2
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Abstract

Objectives Our aim was to evaluate the influence of a calcium channel blocking agent of the dihydropyridine group (nicardipine) on coronary vasomotion during dynamic exercise.Background Coronary vasomotion plays an important role in the pathophysiology of myocardial ischemia.Methods Twenty-nine patients with coronary artery disease were studied at rest and during bicycle exercise with the use of biplane quantitative coronary angiography. Twelve patients without pretreatment (group 1) served as control subjects. Seventeen patients (group 2) received nicardipine, either 0.2 mg by intracoronary injection (n = 9) or 2.5 mg intravenously (n = 8) before exercise.Results In the control group there was exercise-induced vasoconstriction (-29%, p < 0.001) of the stenotic segment but coronary vasodilation (+22%, p < 0.05) of the normal vessel segment. In group 2, nicardipine induced coronary vasodilation of both the normal (+16%, p < 0.001) and the stenotic vessel segment (+35%). During subsequent exercise there was some additional vasodilation of normal (+4%, p = NS) and stenotic arteries (+5%, p = NS). There was no difference between either intracoronary or intravenous nicardipine with regard to vasodilation. Application of sublingual nitroglycerin was associated with significant vasodilation of the normal vessel segment in groups 1 (+18%, p < 0.05) and 2 (+15%, p < 0.001). The stenotic vessels showed a significant increase in percent cross-sectional area after nitroglycerin in groups 1 (+12%, p = NS) and 2 (+51%, p < 0.001). Exertional angina pectoris occurred less frequently in group 2 (18%) than in group 1 (67% [p < 0.005 vs. group 2]); group 2 also had a smaller increase in mean pulmonary artery pressure (+14 vs. +21 mm Hg, p < 0.05).Conclusions Exercise induces vasoconstriction of stenotic, but vasodilation of normal, coronary vessel segments. Intravenous and intracoronary nicardipine prevent vasoconstriction of stenotic coronary arteries during exercise and exert a significant anti-ischemic effect. The combination of two anti-ischemic drugs, nitroglycerin and nicardipine, has an additive effect on coronary vasomotion that is seen only in the stenotic vessel segment. Thus, the anti-ischemic action of nicardipine is mainly due to a primary effect on coronary vasomotor response rather than to secondary effects such as changes in loading conditions.

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  • Exercise workload in the supine position usually matches approximately 70% of the workload achieved in the upright position.

    “however, this was because exercise workload in the supine position usually matches approximately 70% of the workload achieved in the upright position (35,36).”

    From Caffeine decreases exercise-induced myocardial flow reserve (2006) · cites this paper as [35]

    The Study protocol says supine exercise was increased until it reached approximately 70% of each patient’s upright workload. The Results report mean supine-to-upright workloads of 81/129 W and 83/121 W, broadly consistent with that approximation. But the paper describes a workload deliberately set by this study’s protocol; it does not establish that supine workload usually reaches that proportion in general. (LLM, conf=0.83)

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Research works printed but not linked: 3

  1. [2]2. Mates RE, Gupta RL, Bell AC, Klockc FJ. [quid dynamics uf coronary artery stenosis. Circ Res 1978;42:152-62.
  2. [30]30. /I. Bassenge E, Steward DJ. Interdependence of pharmacology induced and September 1995:624 31 CORONARY VASOMOTION DURING EXERCISE endothelium-mediated coronary vasodilation in antianginal therapy. Cardio- vase Drugs Ther 1988;1:47-55.
  3. [34]34. Kuga T, Tagawa H, Tomoike H. Role of coronary artery, spasm in progres- sion of organic coronary stenosis and acute myocardial infarction in a swine model. Circulation 1993;87:573-82.

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Authors
Kaufmann, P., Vassalli, G., Utzinger, U., & Hess, O. M.
Affiliations
University Hospital Zurich (CH)
Corresponding author
Hess, Otto M.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1995-09
Volume
26
Issue
3
Pages
624-631
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/0735-1097(95)00247-2
OpenAlex
W2007775090
Cited by
26
References
39
Citations by year
2023: 1 · 2014: 1
FWCI
2.12
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
coronary vasomotion, nicardipine, calcium channel blockers, dihydropyridines, dynamic exercise, coronary artery disease, exercise-induced vasoconstriction, coronary vasodilation, intracoronary administration, nitroglycerin, pulmonary artery pressure, myocardial ischemia, coronary artery stenosis
MeSH terms
Aged, Analysis of Variance, Coronary Disease, Coronary Vessels, Exercise Test, Female, Cardiac Catheterization, Humans, Infusions, Intra-Arterial, Infusions, Intravenous, Male, Middle Aged, Nicardipine, Vasoconstriction, Vasodilation, Exercise, Coronary Angiography

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