Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol.
OBJECTIVE
To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease.


METHODS
138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either mibefradil or atenolol for 6 weeks (50 mg once daily for 2 weeks followed by 100 mg once daily for 4 weeks). The ratio between early (E) and late (A) diastolic mitral flow velocities (E/A), the E wave deceleration time (DT) and the left ventricular isovolumetric relaxation time (IRT) were measured by Doppler echocardiography as parameters of left-ventricular diastolic function initially, after 4 and after 6 weeks of treatment.


RESULTS
Mibefradil did not change the E/A ratio significantly (+4%, NS), while atenolol treatment resulted in a significant increase in the E/A ratio (+20%, p < 0.001). Mibefradil treatment, on the other hand, resulted in a significant decrease (-8%, p < 0.001) in IRT, while atenolol treatment did not change IRT. Neither mibefradil nor atenolol treatment changed DT significantly.


CONCLUSIONS
Both mibefradil and atenolol treatment significantly improves echocardiographic indices of left-ventricular diastolic function in patients with chronic stable angina. However, they affect different parameters and thus apparently act through different mechanisms.
Hassager
C
C
Department of Medicine B, Rigshospitalet, Copenhagen, Denmark. hassager@dadlnet.dk
Thygesen
K
K
Grande
P
P
Fischer Hansen
J
J
Mickley
H
H
Gustafsson
I
I
Skagen
K
K
Steensgaard-Hansen
F
F
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D001262:Atenolol / Q000627:therapeutic use*; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003971:Diastole / Q000187:drug effects* / Q000502:physiology*; D004311:Double-Blind Method; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008297:Male; D020748:Mibefradil / Q000627:therapeutic use*; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology*
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D020748:Mibefradil; D001262:Atenolol