Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

With eight cases of stable exertional angina as subjects, the antianginal action and sustained effects of single 10 mg oral doses of new calcium antagonists amlodipine were assessed by treadmill exercise tests in randomized crossover trials with respect to a placebo. Exercise tests were conducted before as well as 4, 8, and 24 hours after administration, and plasma amlodipine concentration was investigated at the same times. The maximal exercise time was 299 +/- 43 seconds before as compared with 346 +/- 49 seconds 4 hours after administration and 368 +/- 50 seconds 8 hours after administration, a significant prolongation in each case (p < 0.01). Moreover, the exercise time elapsed until 1 mm of ST-segment depression, as well as the ST-segment depression measured at the same time, were both significantly improved as compared with the placebo results. The plasma amlodipine concentration reached a peak 8 hours after administration and displayed an effective level even 24 hours after administration. The value of delta PRP measured at the same time during the exercise test was also significantly reduced as compared with the placebo results, even 24 hours after administration of amlodipine. These findings supported the conclusion that single 10-mg doses of amlodipine provide stable antianginal action over a 24-hour period.
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PMID:Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing--a randomized crossover study in comparison with placebo. 145 93

A total of 360 consecutive male patients with complaints of chest pain and documented coronary artery disease underwent a maximal exercise test combined with thallium myocardial scintigraphy. Patients with a history of previous myocardial infarction were excluded. During follow-up (46 months; from 12 to 96) 27 patients died and 26 had a first non-fatal myocardial infarction. The 6-year survival rate and the 6-year event-free rate were 81 and 71%. Four variables contributed independently to the prognosis (Cox Model): the number of diseased vessels, the angiographic ejection fraction, the age and a multivariate score of the exercise test. From these patients, 227 had an abnormal response to exercise (ST-segment depression greater than or equal to 0.1 mV); in 138 patients, angina pectoris was induced during exercise while 89 patients had no pain during exercise (silent ischaemia). These 89 patients with silent exertional ischaemia were matched to 89 patients with exertional angina pectoris, according to the above-mentioned four prognostic predictors. The two groups of patients had similar signs of ischaemia during exercise (ST-segment depression and thallium perfusion score). The 6-year survival rates (81 and 81.5%) and the 6-year event-free rates (71 and 70.5%) were similar in the two groups. Thus, in men without previous myocardial infarction, silent exertional ischaemia bears the same prognosis as exertional ischaemia attended by angina pectoris.
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PMID:Prognostic significance of silent exertional myocardial ischaemia in symptomatic men without previous myocardial infarction. 155 14

Circadian variation of ischemic threshold in chronic stable exertional angina was determined in 51 patients with documented coronary artery disease from the Holter monitor results. The peak favored time zones of ischemic attacks were 8 a.m. and 9 a.m. There was no difference in frequency of ischemic attacks, magnitude of ST-segment depression, or duration of ST-segment depression between the two time zones for ischemic attacks, 6-9 a.m. and 0-3 p.m., but the ischemic threshold was lower in the morning than in the afternoon. These observations suggest that the pathogenesis of ischemic attacks differs from one time zone to the other and is considered helpful in planning therapeutic strategies for myocardial ischemia.
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PMID:Circadian variation of ischemic threshold in patients with chronic stable angina. 156 81

The number of underperfused myocardial segments, the extent of coronary artery disease and the severity of impairment of coronary flow reserve were compared in 147 consecutive patients exhibiting painful or painless ischaemic ST segment depression on exercise testing. Of 147 patients, only 61 (41%) experienced angina (group 1) whilst 86 (59%) did not (group 2). In the two groups coronary disease was comparable for both extent and distribution, and neither the location of transient perfusion defects nor their relation to areas of old myocardial necrosis appeared to influence the presence or absence of chest pain. However, exercise duration, exercise time and rate-pressure product at the beginning of ischaemia were lower in group 1. Furthermore, a greater proportion of asymptomatic patients had only one ischaemic segment on 99mTc-MIBI perfusion scintigraphy. We conclude that: (1) in patients with effort angina and coronary disease, the incidence of electrocardiographic silent ischaemic events induced by exercise is similar to that observed in studies based on continuous ECG monitoring. (2) Exertional angina is more frequently associated with greater ischaemic areas and with more severe degrees of impairment of residual coronary flow reserve. (3) The presence of an old myocardial infarction does not appear to influence the incidence of ischaemic cardiac pain.
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PMID:Prevalence of silent myocardial ischaemia during exercise stress testing. Its relation to effort tolerance and myocardial perfusion abnormalities. 164 86

We studied the short-term effects of oral administration of nisoldipine (10 mg) and propranolol (80 mg) alone and in combination in 14 patients with chronic exertional angina pectoris in a double-blind, randomized, cross-over study. The 14 patients (13 men and 1 woman, mean age 56 +/- 7 years) performed symptoms-limited bicycle exercise stress test 3 h after placebo or active substance administration. Maximal work load, exercise duration, and time to 1-mm ST segment depression were significantly increased and ST depression at peak exercise was significantly decreased by drugs alone and in combination. Propranolol and nisoldipine alone improved exercise duration similarly and as well as the combination; however, a different response to the three pharmacologic interventions was found in patients treated with single drugs. The improvement in exercise tolerance was associated with rate-pressure product values at peak exercise, unchanged after nisoldipine and significantly reduced after both propranolol alone and in combination. After placebo, all patients had exercise-induced angina, in 9, 8, and 4 patients after nisoldipine, propranolol, and the combination of the two drugs, respectively. Nisoldipine is effective in the treatment of effort angina and its combination with propranolol may be useful and superior in patients who show poor response to monotherapy.
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PMID:Acute effects of nisoldipine, propranolol, and their combination in patients with chronic stable angina: a double-blind, randomized, cross-over, placebo-controlled study. 169 90

The effects of propionyl-L-carnitine on exercise tolerance of 12 patients with stable exertional angina were assessed in a double-blind, placebo-controlled, cross-over protocol using serial exercise tests. Compared to placebo, propionyl-L-carnitine significantly increased total work from 514 +/- 199 to 600 +/- 209 W (P less than 0.05) (17%) and prolonged exercise time and time to ischemic threshold from 515 +/- 115 to 565 +/- 109 sec (P less than 0.05) (10%) and from 375 +/- 102 to 427 +/- 93 sec (P less than 0.01) (14%), respectively. ST segment depression at the highest common work level was significantly reduced from 0.19 +/- 0.08 to 0.15 +/- 0.08 mV (P less than 0.05) (21%). No significant changes in heart rate, systolic blood pressure, and rate-pressure product at rest, at the highest common work level, on appearance of the ischemic threshold, or at peak exercise were observed after propionyl-L-carnitine treatment. No side effects were observed under propionyl-L-carnitine treatment. This study shows that propionyl-L-carnitine can significantly improve exercise tolerance in patients with stable angina. Our data seem to confirm that propionyl-L-carnitine most likely exerts its protective action via the metabolic pathway.
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PMID:Propionyl-L-carnitine: a new compound in the metabolic approach to the treatment of effort angina. 173 67

Attenuation of antianginal effects of oral isosorbide dinitrate in a sustained release from (ISDN-SR) were studied using the treadmill exercise test in eleven patients with stable exertional angina and a positive exercise test. We compared the four-time-daily administration of 20 mg with a twice-daily regimen of 40 mg for 10 days using the double-blind, crossover method. On the 1st day of the administration, with both regimens, the treadmill walking time, the time to 1mm and 2mm ST depression, and several hemodynamic parameters increased significantly. These improvements were reduced gradually on day 5 and day 10 after the administration. In the comparison between the four-time-daily and two-time-daily regimens, the former application showed clearer antianginal and hemodynamic effects than the latter regimen, but these effects were attenuated more markedly in the four-time daily administration. With both dosage regimens, the plasma ISDN concentrations increased gradually. With the long-term four-time-daily regimen, the time-to-time changes of the ISDN concentration were smaller each day. These data suggest that tolerance to oral ISDN-SR exists even if it is applied only two time daily, but its degree is less than when a four-time-daily dose in administered.
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PMID:[Tolerance to a sustained release form of isosorbide dinitrate: comparison between 20 mg four times and 40 mg twice-daily administrations]. 174 71

To investigate the antiischemic efficacy and duration of action of the dihydropyridine calcium antagonist felodipine, 15 patients with stable exertional angina were enrolled in a double-blind, crossover study comparing 2 doses (5 and 10 mg) of felodipine extended release (ER) and placebo given once daily for 1 week. Bicycle exercise tests were repeated at the end of each treatment period 4 and 24 hours after dosing. Four hours after dosing with both felodipine doses, only 5 patients discontinued the exercise test because of greater than 2 mm of ST-segment depression, whereas 10 continued until exhaustion (p less than 0.01 vs placebo). Compared with placebo, total exercise time was increased by 19% (p less than 0.001), with no difference between doses. After 24 hours, exercise duration was prolonged up to physical exhaustion in 6 patients taking felodipine 10 mg (p less than 0.05 vs both placebo and felodipine 5 mg); moreover, 11 patients taking 10 mg and 5 taking 5 mg increased time to 1 mm of ST depression greater than or equal to 15% compared with exercise time during the placebo test. Mean time to 1 mm of ST depression at 24 hours was increased by 8% with 5 mg and by 18% with 10 mg (p less than 0.001 vs placebo; p less than 0.01 between doses). Total exercise time at 24 hours was increased with both doses (p less than 0.001), with greater efficacy with the 10-mg dose (p less than 0.05 vs 5 mg).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Twenty-four-hour activity of felodipine extended release in chronic stable angina pectoris. 187 71

In order to assess the role of alpha-adrenergic coronary tone in exercise-induced ischemia, 23 patients with chronic stable angina underwent, after coronary angiography, a symptom-limited supine exercise test on a cyclo-ergometer. After recovery, either phentolamine (for the first nine patients) or indoramin (for the following nine patients) was directly injected into the most diseased vessel at identical doses (2 mg over 5 min). In the remaining 5 patients, a placebo was injected. Immediately thereafter the same exercise (identical workloads and exercise duration) was repeated. During exercise 1, heart rate (HR), mean blood pressure, and cardiac index increased by 51%, 23% and 33% in the phentolamine group, and by 45%, 15%, and 33% in the indoramin group. After intracoronary injection of phentolamine or indoramin, control values (including pulmonary artery wedge pressure (PA wedge] at rest did not change significantly. During exercise 2, HR, mean blood pressure, and cardiac index increased in a similar way; however, the increase in PA wedge was less pronounced (p less than 0.01 in the phentolamine group and p less than 0.05 in the indoramin group). ST-segment depression at the end of exercise 2 was significantly smaller for identical workloads and double products in the phentolamine group: 1.5 +/- 0.3 mm vs 2.5 +/- 0.3 mm (p less than 0.01). However, these changes did not reach a statistical significance in the indoramin group: 1.7 +/- 0.2 mm vs 2.0 +/- 0.1 mm (NS). ST/HR slope in exercise 2 decreased by 51% (p less than 0.01) in the phentolamine group and by 34% (p less than 0.05) in the indoramin group. In the placebo group, exercise 2 was identical to exercise 1 and the ST/HR slopes were quite reproducible. These results show a less severe ischemic response after intracoronary alpha-blockade. Therefore, our results argue for a role of alpha-adrenergic coronary tone in exertional angina. The relatively higher efficiency of phentolamine vs indoramin suggests that alpha 2-adrenergic mechanisms contribute to the inappropriate coronary vasoconstriction during exercise in these patients.
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PMID:Alpha-adrenergic coronary constriction in effort angina. 196 3

Antianginal and antiischemic effects and clinical pharmacologic actions of carvedilol, a novel beta-blocking agent with a vasodilator action, were determined by Holter electrocardiographic monitoring in 13 patients with exertional angina. The patients were observed for 1 week prior to entry into the study, followed by 1 to 2 weeks of treatment with carvedilol. During the observation period the patients received one placebo tablet daily, and during the treatment period one 20 mg tablet of carvedilol daily. Before and after the treatment 24-hour Holter electrocardiographic tracings were obtained. The mean interval of Holter monitoring was 11.2 +/- 4.5 days for the observation and treatment periods, and the mean time of drug administration was 8:25 a.m. (+/- 30 min). The Holter electrocardiographic tracings which were obtained twice in 9 patients during the observation period showed a high degree of reproducibility with respect to the frequency, magnitude and duration of ST-segment depression. The total frequency of ST depression per patient was 4.5 +/- 3.4 events/day pre-drug and 2.1 +/- 2.1 events/day post-drug. There was a significant reduction in total frequency of ST depression post-drug (p less than 0.01). The frequency of asymptomatic ST depression was similarly decreased post-drug (p less than 0.01), and the total magnitude and duration of ST depression were significantly improved post-drug (p less than 0.01 and p less than 0.05, respectively). These effects of carvedilol lasted for 24 hours after administration. Considering that the heart rate was not excessively reduced during the night, and nocturnal myocardial ischemic episodes were not exacerbated, the mode of action of this drug seems to be based on not only a beta-blocking action but also on a vasodilator action. Carvedilol benefits exertional angina when used in a 20 mg s.i.d. regimen.
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PMID:Evaluation of a new vasodilating beta-blocking agent, carvedilol, in exertional angina using holter monitoring. 197 39


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