[Anti-ischemic efficacy of sustained-release isosorbide-5-mononitrate: echocardiography during mental and physical stress].

This double-blind, placebo-controlled study investigated the anti-ischemic efficacy of sustained-release isosorbide-5-mononitrate (IS-5-MN) 100 mg/day on the basis of stress echocardiography and stress ECG in patients subjected to physical (bicycle ergometry) and mental stress (mental stress test). Forty male patients with a stress-induced ST segment depression of > 0.1 mV during bicycle ergometry who received beta blocker background therapy were randomized into the 14-day treatment phase (IS-5-MN: 20 patients, placebo: 20 patients). After 2 weeks of treatment, a significant prolongation of the time to 0.1 mV ST segment depression and of the time to stress-induced anginal attacks could be demonstrated for IS-5-MN in the stress echocardiography. A significantly greater reduction in the wall motion score determined via stress echocardiography was found in IS-5-MN-treated vs. placebo-treated patients relative to baseline. There were only 4 patients who developed ST segment depression during mental stress; however, the echocardiography demonstrated a significantly greater reduction of the wall motion score after 2 weeks of treatment vs. baseline in the IS-5-MN vs. the placebo group. The efficacy of sustained-release IS-5-MN 100 mg/day was proved in this study both by stress echocardiography, and stress electrocardiography in situations of physical and mental stress. It was found that echocardiography is more sensitive for detecting ischemic reactions induced by mental stress than ECG.