Copyright © 1995 by the European Society of Cardiology.
© 1995 The European Society of Cardiology
Protective effect of beta-blockade on dipyridamole-induced myocardial ischaemia
Role of heart rate
Istituto di Medicina Interna, Cardiologia, Chirurgia Cardiovascolare, Cattedra di Geriatria, Facolta' di Medicina e Chirurgia, Universita' degli Studi di Napoli "Federico II" Naples
*Fondazione Clinica del Lavoro-I.R.C.C.S. Campoli MT (BN) Italy
revised 29 September 1994; accepted 28 October 1994.
Correspondence: Nicola Ferrara, MD, Ist. Med. Interna, Cardiologia, Chirurgia Cardiovascolare, Cattedra di Geriatria, II Facolta' di Medicina e Chirurgia, via S. Pansini, 5 – 80131 Naples, Italy.
Abstract
This study was designed to investigate the effect of heart rate changes on dipyridamole echocardiographic tests in patients with coronary artery disease treated with propranolol.
We prospectively studied 12 patients (8 men and 4 women; mean age 56.5 ± 8.7 years) selected by: (a) angiographic evidence of significant coronary artery disease; (b) adequate echocardiographic window; (c) positive dipyridamole echocardiography test results in baseline conditions (step I); (d) test reproducibility in the absence of treatment; (e) negative dipyridamole echocardiography test results after 7 days of treatment with propranolol (120 mg. day–
1) in twice divided doses daily (step II).
In all patients treated with propranolol, dipyridamole echocardiographic testing was repeated 24 h after the last negative test. In these patients, transoesophageal atrial pacing was performed at peak dipyridamole infusion to increase heart rate to values similar to those observed at baseline (step III). At baseline, heart rate and rate-pressure product were significantly lower in patients treated with propranolol (–20.3% and –22.5% in group II, P<0–001 vs step I; –24.3% and –26.4% in group III, P<0.05 vs step I), but the different treatments did not produce significant differences in systolic and diastolic blood pressure. At peak dipyridamole infusion, heart rate and rate-pressure product increased with either placebo or propranolol treatments with respect to baseline, while remaining significantly lower with propranolol as compared to placebo ( –29.6% and –29.5% in step II, P<0001). During treatment with propranolol plus transoesophageal pacing to maintain heart rate at values attained with placebo, the rate-pressure product did not change significantly with respect to placebo, nor did systolic blood pressure. Transoesophageal atrial pacing performed during propranolol treatment to restore heart rate to baseline values did not affect the dipyridamole echocardiographic test in eight patients (group I), and induced transient wall abnormalities in four patients (group II) (P=ns).
Our data suggest that the anti-ischaemic effect of propranolol in man is not correlated only to reduction of heart rate.
Key Words: Beta-adrenoceptor blockade • dipyridamole • atrial pacing • myocardial ischaemia • echocardiography
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