Pichler M, Brandt D, Teubl H, Dorda W
Rehabilitationszentrum, Universität Wien.
Wien Klin Wochenschr. 1995;107(13):390-5.
Thirty six patients with documented coronary artery disease and exercise-induced silent ischemia were evaluated in a double-blind randomised placebo-controlled crossover study. The effect of once daily 60 mg sustained-release isosorbide-5-mononitrate (IS-5-MN) was tested on exercise-induced and ambulatory silent ischemia. After a wash-out period in which no cardioactive drugs were administered, each patient received IS-5-MN for the first week, followed by placebo for the second week, or vice versa. A symptom-limited bicycle exercise test and Holter monitoring over a 24-hour period were performed after wash-out and at the end of each one-week treatment period. In comparison with wash-out IS-5-MN significantly (p < 0.05) prolonged time on onset of 1 mm ST-segment depression during exercise testing. On the other hand, the number and circadian variation of ischemic episodes during Holter monitoring were not influenced by IS-5-MN. Thus, 60 mg IS-5-MN once daily significantly improved silent ischemia during exercise testing but not during Holter monitoring. This discrepancy may be due to different pathogenetic mechanisms of ischemia during ergometry as opposed to the everyday situation; nitrates may also provoke silent ischemia by increasing the heart rate. Furthermore, the choice of only one antiischemic drug at a fixed dosage may not be aggressive enough in suppressing ischemia completely.
在一项双盲随机安慰剂对照交叉研究中，对36例有冠状动脉疾病记录且存在运动诱发无症状性心肌缺血的患者进行了评估。测试了每日一次60毫克缓释单硝酸异山梨酯（IS-5-MN）对运动诱发和动态无症状性心肌缺血的影响。在一个未给予任何心血管活性药物的洗脱期后，每位患者在第一周接受IS-5-MN，第二周接受安慰剂，或者反之。在洗脱期结束时以及每个为期一周的治疗期结束时，进行了症状限制的自行车运动试验和24小时动态心电图监测。与洗脱期相比，IS-5-MN在运动试验期间显著（p<0.05）延长了出现1毫米ST段压低的时间。另一方面，动态心电图监测期间缺血发作的次数和昼夜变化不受IS-5-MN影响。因此，每日一次60毫克IS-5-MN在运动试验期间显著改善了无症状性心肌缺血，但在动态心电图监测期间未改善。这种差异可能是由于与日常情况相比，运动试验期间缺血的发病机制不同；硝酸盐也可能通过增加心率诱发无症状性心肌缺血。此外，在固定剂量下仅选择一种抗缺血药物可能在完全抑制缺血方面不够积极。
