Abstract
Aim. To reveal possible hemodynamic aerobic mechanisms of exercise tolerance improvement in stable angina patients having taken the typical pharmacological antianginal group drugs: nitrates, beta-blockers, calcium channel blockers. Material and methods. Totally, 164 stable angina male patients of II-IV functional class, participated in the study (mean age 55,2±2,1 years), who underwent doubled veloergometry before and after single intake of a mean therapeutical dosage of propranolol (PR) (n=58), isosorbidi dinitras (ID) (n=54), nifedipine (NF) (n=52). At the threshold of exercise intensity, the oxygen consumption (VO 2 ) was measured, cardiac index (CI), arteriovenous gradient by oxygen (АVРО 2 ), peripheral vascular resistance (PVS), and Robinson index (RI). Results. The efficacy of single NF dosage was found in 55,5% of angina patients, ID — in 48%, and PR — in 58%. The increase of threshold intensity was supported by an adequate VO2, which, after the PR intake was realized within analogous to the baseline CI parameters (4,6±1,7 L/min/m 2 and 4,9±1,7 L/min/m 2 ). In this case АVРО 2 was higher than baseline by 43,1% (p<0,001). Increase of exercise tolerance by the same value after the intake of NF was followed by CI increase comparing to the primary values, by 40,5% (p<0,001) and increase of RI from 157,7±39,0 units to 210,0±68,6 units (р<0,001). Value of АVРО 2 did not change. Intake of ID also was followed by significantly higher threshold values of CI and RI, however, less prominent comparing to PR (by 9,6 and 17,6%), which also were followed by 39,8% increased oxygen extraction from blood (p=0,018). Conclusion. Antianginal effect of the drugs is mediated primarily by activation of the various parts of oxygen transporting system than realizes additional oxygen transport to working tissues (muscles). Intensification of oxygen transportation might be followed by the increase of hemodynamic productivity (NF), mostly by activation of extracardiac oxygen consumption factors (PR) and combination of both (ID).
Highlights
The efficacy of single NF dosage was found in 55,5% of angina patients, isosorbidi dinitras (ID) — in 48%, and PR — in 58%
Increase of exercise tolerance 2 by the same value after the intake of NF was followed by cardiac index (CI) increase comparing to the primary values, by 40,5% (p
Intake of ID was 2 followed by significantly higher threshold values of CI and RI, less prominent comparing to PR, which were followed by 39,8% increased oxygen extraction from blood (p=0,018)
Summary
Прирост мощности пороговой нагрузки обеспечивался адекватным увеличением VO , которое после приема ПР осуществлялось при аналогичных исходным показателях. Отделения артериальной гипертонии и коронарной недостаточности научного отдела клинической кардиологии, Стрельцова Н. ААП — антиангинальные препараты, АВРО — артерио-венозная разница 2 по кислороду, АД — артериальное давление, АДср — среднее артериальное давление, ДП — двойное произведение, ИБС — ишемическая болезнь сердца, ИД — изосорбида динитрат, КА — коронарные артерии, О П — “кислородный пульс”, НФ — нифедипин, ОПСС — общее периферическое сосудистое сопротивление, ПР — пропранолол, РС — механическая работа сердца, СВ — сердечный выброс, СН — стенокардия напряжения, СИ — сердечный индекс, УПК — удельное потребление кислорода, ЧCC — частота сердечных сокращений, ФН — физическая нагрузка, ∆VO /∆РС — аэробная эффективность сердечной деятельности, VO — потребление кислорода, W — мощность физиче ской нагрузки, W/∆ДП — показатель эффективности энергетических затрат сердца. To reveal possible hemodynamic aerobic mechanisms of exercise tolerance improvement in stable angina patients having taken the typical pharmacological antianginal group drugs: nitrates, beta-blockers, calcium channel blockers
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