HEMODYNAMIC AEROBIC MECHANISMS OF EXERCISE TOLERANCE INCREASE IN STABLE ANGINA PATIENTS ON ANTIANGINAL TREATMENT

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 (VO₂) was measured, cardiac index (CI), arteriovenous gradient by oxygen (АVРО₂), 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/m² and 4,9±1,7 L/min/m²). In this case АVРО₂  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 АVРО₂ 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).

angina, antianginal medications, antianginal mechanism

1. Braunwald’s Heart Disease. A Textbook of Cardiovascular Medicine. Vol 1. М.: Logosfera, 2010. p. 624. Russian (Болезни сердца по Браунвальду. Руководство по сердечнососудистой медицине. Том 1. М.: Логосфера, 2010 с. 624).

2. The ESC Textbook of Cardiovascular Medicine. AD Kjemm, TF Ljusher, PV Serruis (eds). M.: GJeOTAR-Media, 2011. p. 2289. Russian (Болезни сердца и сосудов. Руководство Европейского общества кардиологов. А. Д. Кэмм, Т. Ф. Люшер, П. В. Серруис (ред). М.: ГЭОТАР-Медиа, 2011. с. 2289).

3. Albertal M, Regar EM. Langenhove1 GVan et al. On behalf of the DEBATE investigators. Flow velocity and predictors of a suboptimal coronary flow velocity reserve after coronary balloonangioplasty. Eur. Heart J 2002; 23: 133-8.

4. Aleksandrov AA, Chukaeva II. Mircocirculatory ischemia and statins: interventional cardiology. Rational Pharmacotherapy in Cardiology 2007; 1: 48-54. Russian (Александров А. А., Чукаева И. И. Микроциркуляторная ишемия и статины: уроки интервенционной кардиологии. Рациональная фармакотерапия в кардиологии 2007, 1: 48-54).

5. Dedov II. Diabetes mellitus: technologies in diagnostics, treatment and prevention (plenary lecture). Diabetes mellitus 2010; 3 (48): 6-13. Russian (Дедов И. И. Сахарный диабет: развитие технологий в диагностике, лечении и профилактике (пленарная лекция). Сахарный диабет 2010, 3 (48): 6-13).

6. Majorov AJu. Congress IDF-2011: new treatment of patients with DM type 2. Jeffektivnaja farmakoterapija 2012; 45: 2-4. Russian (Майоров А. Ю. Конгресс IDF-2011: представлен новый алгоритм лечения больных с СД 2 типа. Эффективная фармакотерапия 2012, 45: 2-4).

7. Guyton CA. Textbook of Medical Physiology. Guyton CA, Hall JE (eds). Elsevier Saunders 2006. p. 1168.

8. Aronov DM, Lupanov VP. Functional tests in cardiology. 3 edition. M.: MEDpress-inform 2007. p. 328. Russian (Аронов Д. М., Лупанов В. П. Функциональные пробы в кардиологии. 3 издание. М.: МЕДпресс-информ, 2007. с. 328).

9. Brin VB. The Physiology of Systematic Blood Circulation. Formulae and Calculations. Rostov: Rostovskij universitet, 1984. р. 88. Russian (Брин В. Б. Физиология системного кровообращения: формулы и расчеты. Ростов: Ростовский университет, 1984. с. 88).

10. Clinical pharmacology. Kukes VG (eds). M.: GJeOTAR-Media, 2013. р. 1056. Russian (Клиническая фармакология. Кукес В. Г. (ред). М.: ГЭОТАР-Медиа, 2013. с. 1056).

11. Ljul’man H, Mor K, Hajn N. Visual pharmacology. M.: Mir, 2008. p. 384. Russian (Люльман Х, Мор К, Хайн Н. Наглядная фармакология. М.: Мир 2008. с. 384).

12. Pathophysiology. Vol.2. Novickij VV, Gol’dberg ED, Urazova OI (eds). M.: GJeOTAR-Media, 2013. р. 635. Russian (Патофизиология. Том 2. Новицкий В. В., Гольдберг Е. Д., Уразова О. И. (ред). М.: ГЭОТАР-Медиа, 2013. с. 635).

13. Karpova NJu, Rashid MA. Coronary artery disease and arterial hypertension: new application of calcium antagonists. Lechebnoe delo 2009; 3: 50-9. Russian (Карпова Н. Ю., Рашид М. А. Ишемическая болезнь сердца и артериальная гипертензия: новые возможности применения антагонистов кальция. Лечебное дело 2009, 3: 50-9).

14. Votchal BE. Sketches of Clinical Pharmacology. M.: MIA, 2007. р. 464. Russian (Вотчал Б. Е. Очерки клинической фармакологии. М.: МИА, 2007. с. 464).