Enrico Onnis

Propionyl carnitine in stable effort angina.

SummaryThe aim of this study was to investigate the antiischemic activity of propionyl carnitine (PC) in 18 informed, volunteer male patients, aged 37–70, suffering from a typical stable effort angina. The study design was randomized, balanced, crossover, and double blinded. The study lasted 75 days. In the first 15 days of washout the patients performed two maximal symptom-limited bicycle tests to verify the repeatability of the parameters examined. Then one group received PC for 30 days 500 mg three times a day, and the other group received placebo (PL) three times a day. At the end of 30 days the groups exchanged treatments. At the end of each period, 2 hours after the last oral administration, the patients performed a maximal symptom-limited bicycle exercise test with increased loads of 10 watts/min. No significant differences were observed between the two tests performed during the wash-out period, for a 1mm ST-segment depression time, for the time to the end of exercise, and for the rate x pressure product at the same experimental time. The oral administration of PC in coronary patients increased both the 1 mm ST-segment depression time and the time to the end of exercise. Furthermore, the drug reduced the ischemic depression of ST at maximal common work and at maximal work. After PC, the rate x pressure product was not significantly different in relation to placebo at submaximal and maximal exercise. Thus PC seems to have an antiischemiclike effect, probably related to its metabolic activity.

Felodipine Improves the Anti-Ischaemic Effect of Metoprolol in Stable Effort-Induced Angina

SummaryThe anti-ischaemic effects of sustained release felodipine 10 mg/day, metoprolol 200 mg/day and both drugs together were assessed in 16 male patients with stable effort-induced angina pectoris in a randomised double-blind crossover study. At the end of each 7-day treatment period, patients performed a maximum symptom-limited cycloergometer exercise test. All 3 active regimens significantly (p < 0.05) increased the ischaemic threshold (time to 1mm ST-segment depression) and exercise capacity (time to angina pain or exhaustion), and decreased ST-segment depression at maximum common workload vs placebo. The combination regimen produced a significantly greater effect on ischaemic threshold and ST-segment depression at maximum workload and maximum common workload than felodipine alone, and a greater effect on ST-segment depression at maximum common workload than metoprolol alone. Rate-pressure product at ischaemic threshold and maximum workload was increased by felodipine and decreased by metoprolol or the combination regimen. Thus, the combination of felodipine with metoprolol resulted in greater anti-ischaemic activity than that observed with either drug alone, reflecting their different, but complementary, mechanisms of action.

Antianginal and Anti-Ischaemic Activity of Nebivolol in Stable Angina of Effort

SummaryNebivolol is a racemic adrenergic β-blocker, with β-blocking activity that is essentially due to its d-enantiomer.The anti-ischaemic activity of nebivolol was investigated in 16 patients with stable angina of effort, with a fixed ischaemic threshold (variations < ± 15%).After a 10-day washout period, patients were randomised to treatment with either nebivolol 5mg daily or placebo for 14 days. Patients underwent maximal symptom-limited exercise tests (10 W/min on a bicycle) during washout (twice), and after the completion of each treatment period. Patients were studied by ECG and systolic blood pressure measurement (cuff method). After nebivolol treatment, ischaemic and anginal thresholds were increased for at least 8 hours compared with placebo (ischaemic threshold: nebivolol 637.5 ± 47sec; placebo 534.3 ± 38sec; p < 0.01; anginal threshold: nebivolol 754.6 ± 59sec; placebo 674 ± 41 sec; p < 0.05). Rate pressure product was significantly decreased at rest and during exercise.In conclusion, nebivolol possesses an anti-ischaemic and antianginal activity lasting at least 8 hours. This activity is mainly due to the reduction in myocardial oxygen consumption.

Slow-release gallopamil in patients with stable effort angina

Summary: Gallopamil (GSR) is a new calcium-channel blocker. The anti-ischemic activity of GSR was investigated in 12 patients with stable angina of effort, with fixed ischemic threshold (variations <15%). After a 7-day washout period, patients were randomized to receive treatment with either GSR 100 mg or placebo twice daily for 7 days. Patients underwent maximal symptom-limited exercise test, 10 W/min on a bicycle, during washout (twice) and after the end of each treatment period. Patients were studied by electrocardiogram and the cuff method for determining systolic blood pressure. After treatment with GSR, ischemic and anginal thresholds were increased for at least 12 h in comparison with placebo (ischemic threshold: GSR 663 ± 37, placebo 571 ± 36, p < 0.01; anginal threshold: GSR 708 ± 32, placebo 646 ± 38, p < 0.05). Rate–pressure product was not changed at the same levels of exercise, but it was significantly increased during exercise at ischemic threshold. In conclusion, GSR possesses an anti-ischemic and antianginal activity lasting at least 12 h. This activity seems due to an increase of coronary blood flow to ischemic areas.

INVASIVE VERSUS CONSERVATIVE THERAPY IN OCTOGENARIANS WITH ACUTE CORONARY SYNDROME

In clinical trials that compare different treatment strategies in patients with acute coronary syndrome (ACS), elderly patients are poorly represented. Aim of this study was to investigate the cost/benefit ratio of invasive versus conservative therapy in ACS octogenarian patients.nnFrom April 2009

Effect of Calcium Antagonists on Exercise Tests

The aim of this study was to investigate the anti-ischemic and antianginal activity and the duration of the new dihydropyridine calcium blocker nisoldipine (NIS) in patients with stable angina pectoris. The research was carried out on 16 patients, all male, 41–68 (mean of 58) years of age, with stable angina pectoris and fixed ischemic threshold (variations <15%). After a 10-day washout period, patients were randomized to treatment with either 10 mg of nisoldipine or placebo (PL), twice daily for 21 days, according to a double-blind, crossover design. Patients underwent maximal symptom-limited exercise testing at 10 W/min on a bicycle ergometer, twice during the washout period, and once at the end of each treatment period, 3 and 12 h after oral administration of the drugs. In comparison with placebo, nisoldipine increased the ischemic threshold (N, 704 ± 45 s; PL, 548 ± 35 s; p < 0.01) and anginal threshold (N, 766 ± 44 s; PL, 699 ± 42 s; p < 0.01) for at least 12 h, and the ST-segment depression significantly decreased at maximal work (PL, 2.4 ± 0.1 mm; N, 1.8 ± 0.2 mm; p < 0.01) and at maximal common work (PL, 2.4 ± 0.1 mm; N, 1.15 ± 0.2 mm; p < 0.01). Similar to placebo the rate-pressure product was not significantly changed at higher submaximal effort after N, but it was significantly increased at the level of ischemic threshold, suggesting an increase in coronary blood flow to ischemic zones. Nisoldipine possesses anti-ischemic and antianginal activity lasting at least 12 h. This activity seems to be due to an increase in coronary blood flow to ischemic zones.