Amlodipine reduces myocardial ischaemia during exercise without compromising left ventricular function in patients with silent ischaemia: a randomised, double-blind, placebo-controlled study

Background: Left ventricular systolic function is reduced during episodes o f silent ischaemia in patients with coronary artery disease (CAD). In most normal subjects left ventricular ejection fraction (LVEF) increases at leas t 5% during exercise whereas LVEF often remains unchanged or decreases in p atients with CAD. The anti-ischaemic effect of calcium antagonists is well documented including a capability to reduce exercise-induced electrocardiog raphic ST-depressions, whereas the effect of these drugs on LV volume chang es during exercise in patients with silent ischaemia is unknown. Aim: The a im of this study was to evaluate the effect of amlodipine on rest and exerc ise LVEF in patients with silent ischaemia. Methods: Twenty-one patients co mpleted a double-blind placebo-controlled cross-over study. Conventional ex ercise test and radionuclide cardiographies during exercise were used for d etermining haemodynamic parameters. Results: Exercise-induced electrocardio graphic ST-depressions were reduced in 83% of the patients having ST-deviat ions during placebo even though 10 patients were already treated with a bet a-blocker. Amlodipine did not affect left ventricular systolic function com pared to placebo, neither at rest nor during exercise. Conclusion: The resu lts indicated that amlodipine is a safe anti-ischaemic drug in patients wit h silent ischaemia concerning cardiac function. (C) 1999 European Society o f Cardiology. All rights reserved.