38154
document
Effect of diltiazem on symptomatic and asymptomatic episodes of ST segment depression occurring during daily life and during exercise . BACKGROUND Silent myocardial ischemia is an adverse prognostic marker in patients with coronary disease ; however , controlled data on the effect of treatment are sparse and contradictory , and the relations among the occurrence of ST segment depression , drug efficacy , and heart rate are unclear . METHODS AND RESULTS Sixty patients with stable coronary artery disease , a positive treadmill exercise test and asymptomatic ST segment depression on ambulatory electrocardiographic recording were assessed in a multicenter , double-blind , placebo-controlled , cross-over trial . Treadmill exercise tests and 72-hour electrocardiographic recordings were obtained at the end of two 2-week treatment periods with sustained-release diltiazem 180 mg b.i.d . or equivalent placebo . Episodes of asymptomatic ST depression decreased by 50 % or more in 70 % of the patients from a median number of 4.5 ( range , 0-19 ) to 1.5 ( range , 0-13 ) ( p = 0.0001 ) ; their cumulative duration also decreased from 78.5 ( range , 0-60 ) to 24.5 ( range , 0-411 ) minutes ( p = 0.001 ) . No circadian variation was found in the efficacy of diltiazem . The occurrence of ischemic type ST segment depression was modulated by changes in heart rate rather than by absolute heart rate . Diltiazem also improved exercise test end points but to a lesser extent . Time to ST segment depression increased to 341 +/- 148 from 296 +/- 154 seconds ( p = 0.005 ) . Although less frequent with diltiazem administration ( 45 versus 54 patients , p less than 0.03 ) , exercise-induced ST depression was more often asymptomatic ( 98 % versus 72 % of patients , p less than 0.0001 ) . CONCLUSIONS Diltiazem reduces the frequency and severity of ischemic type ST depression in patients with stable coronary artery disease .
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Intervention_Pharmacological
diltiazem
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Intervention_Control
placebo-controlled
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Intervention_Physical
Treadmill exercise
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Intervention_Pharmacological
sustained-release diltiazem
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Intervention_Control
placebo .
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Intervention_Pharmacological
diltiazem .
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Intervention_Pharmacological
Diltiazem
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Intervention_Pharmacological
diltiazem
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Intervention_Pharmacological
Diltiazem
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Outcome_Mental
ST segment depression
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Outcome_Mental
ST segment depression
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Outcome_Other
Treadmill exercise tests
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Outcome_Other
72-hour electrocardiographic recordings
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Outcome_Mental
Episodes of asymptomatic ST depression
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Outcome_Physical
cumulative duration
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Outcome_Physical
circadian variation
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Outcome_Physical
ischemic type ST segment depression
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Outcome_Physical
changes in heart rate
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Outcome_Physical
exercise test end points
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Outcome_Physical
Time to ST segment depression
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Outcome_Physical
exercise-induced ST depression
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Outcome_Mental
ischemic type ST depression
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Participant_Condition
ST segment depression
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Participant_Condition
coronary disease
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Participant_Sample-size
Sixty
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Participant_Condition
stable coronary artery disease
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Participant_Condition
positive treadmill exercise test
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Participant_Condition
asymptomatic ST segment depression