TY - JOUR
T1 - Changes in myocardial metabolism during therapy in patients with chronic stable angina
T2 - A comparison of long-term dosing with propranolol and nicardipine
AU - Rousseau, M. F.
AU - Hanet, C.
AU - Pardonge-Lavenne, E.
AU - Van den Berghe, G.
AU - Van Hoof, F.
AU - Pouleur, H.
PY - 1986/1/1
Y1 - 1986/1/1
N2 - The long-term effects of antianginal therapy on coronary blood flow and myocardial metabolism were studied in 35 patients with chronic stable angina. Arterial and coronary sinus blood samples and coronary blood flow measurements were obtained before and after 1 month of oral administration of propranolol or of the calcium antagonist nicardipine. When the data obtained at a fixed heart rate (10% to 15% above the pretreatment sinus rhythm) were compared, no significant differences were evidenced between the propranolol and the nicardipine groups. Coronary blood flow and myocardial oxygen uptake were unchanged with both drugs. Myocardial lactate uptake increased in 11 patients of the propranolol group (from -2 ± 42 to 66 ± 47 μmol/min, p<.001) and in 11 patients of the nicardipine group (from 0 ± 36 to 31 ± 29 μmol/min, p<.001). In these 22 patients, the increase in lactate uptake was accompanied by reductions in uptake of free fatty acids and by a decrease in the coronary sinus concentration of thromboxane B2 from 131 ± 87 to 61 ± 32 pg/ml (p<.01), whereas the transcardiac release of prostacyclin increased. None of these changes in free fatty acids or in prostanoid handling were observed in the nine patients (five in the propranolol and four in the nicardipine group) in whom lactate uptake was not augmented. During pacing-induced tachycardia, the metabolic effects of the two drugs appeared different. Myocardial lactate uptake decreased more in the patients receiving propranolol than in those receiving nicardipine and the combined productions of alanine and glutamine rose by 3.2 ± 5.8 μmol/min in the propranolol group while it decreased by 3.1 ± 8.2 μmol/min in the nicardipine group (p<.025 propranolol vs nicardipine). In conclusion, long-term antianginal therapy with propranolol or nicardipine improved several markers of myocardial ischemia in approximately two-thirds of the patients. Although the changes observed at low heart rates were similar with the two drugs, the data also suggest that better metabolic protection is provided by the calcium antagonist during pacing-induced tachycardia.
AB - The long-term effects of antianginal therapy on coronary blood flow and myocardial metabolism were studied in 35 patients with chronic stable angina. Arterial and coronary sinus blood samples and coronary blood flow measurements were obtained before and after 1 month of oral administration of propranolol or of the calcium antagonist nicardipine. When the data obtained at a fixed heart rate (10% to 15% above the pretreatment sinus rhythm) were compared, no significant differences were evidenced between the propranolol and the nicardipine groups. Coronary blood flow and myocardial oxygen uptake were unchanged with both drugs. Myocardial lactate uptake increased in 11 patients of the propranolol group (from -2 ± 42 to 66 ± 47 μmol/min, p<.001) and in 11 patients of the nicardipine group (from 0 ± 36 to 31 ± 29 μmol/min, p<.001). In these 22 patients, the increase in lactate uptake was accompanied by reductions in uptake of free fatty acids and by a decrease in the coronary sinus concentration of thromboxane B2 from 131 ± 87 to 61 ± 32 pg/ml (p<.01), whereas the transcardiac release of prostacyclin increased. None of these changes in free fatty acids or in prostanoid handling were observed in the nine patients (five in the propranolol and four in the nicardipine group) in whom lactate uptake was not augmented. During pacing-induced tachycardia, the metabolic effects of the two drugs appeared different. Myocardial lactate uptake decreased more in the patients receiving propranolol than in those receiving nicardipine and the combined productions of alanine and glutamine rose by 3.2 ± 5.8 μmol/min in the propranolol group while it decreased by 3.1 ± 8.2 μmol/min in the nicardipine group (p<.025 propranolol vs nicardipine). In conclusion, long-term antianginal therapy with propranolol or nicardipine improved several markers of myocardial ischemia in approximately two-thirds of the patients. Although the changes observed at low heart rates were similar with the two drugs, the data also suggest that better metabolic protection is provided by the calcium antagonist during pacing-induced tachycardia.
UR - http://www.scopus.com/inward/record.url?scp=0022458448&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.73.6.1270
DO - 10.1161/01.CIR.73.6.1270
M3 - Article
AN - SCOPUS:0022458448
SN - 0009-7322
VL - 73
SP - 1270
EP - 1280
JO - Circulation
JF - Circulation
IS - 6
ER -