OBJECTIVE: To determine the acute effects of pyridostigmine bromide, a reversible cholinesterase inhibitor, during exercise in patients with coronary artery disease. DESIGN: Double blind, randomised, placebo controlled, crossover study. SETTING: Outpatients evaluated in an exercise test laboratory. PATIENTS: 15 patients with exercise induced myocardial ischaemia. INTERVENTIONS: Maximal cardiopulmonary exercise test on a treadmill according to an individualised ramp protocol on three days. The first day was used for adaptation to the equipment and to determine exercise tolerance and the presence of exercise induced ischaemia. On the other two days, the cardiopulmonary exercise test was performed two hours after oral administration of pyridostigmine (45 mg) or placebo. All patients were taking their usual medication during the experiments. MAIN OUTCOME MEASURES: Rate-pressure product and oxygen uptake during exercise. RESULTS:Pyridostigmine inhibited the submaximum chronotropic response (p = 0.001), delaying the onset of myocardial ischaemia, which occurred at a similar rate-pressure product (mean (SE) placebo 20.55 (1.08) mm Hg x beats/min 10(3); pyridostigmine 19.75 (1.28) mm Hg x beats/min 10(3); p = 0.27) but at a higher exercise intensity (oxygen consumption: placebo 18.6 (1.7) ml/kg/min; pyridostigmine 19.6 (1.8) ml/kg/min; p = 0.03). Also, pyridostigmine increased peak oxygen consumption (placebo 23.6 (2) ml/kg/min; pyridostigmine 24.8 (2) ml/kg/min; p = 0.01) and peak oxygen pulse (placebo 12.9 (1) ml/beat; pyridostigmine 13.6 (1) ml/beat; p = 0.02). CONCLUSIONS:Pyridostigmine improved peak exercise tolerance and inhibited the chronotropic response to submaximum exercise, increasing the intensity at which myocardial ischaemia occurred. These results suggest that pyridostigmine can protect against exercise induced myocardial ischaemia.
RCT Entities:
OBJECTIVE: To determine the acute effects of pyridostigmine bromide, a reversible cholinesterase inhibitor, during exercise in patients with coronary artery disease. DESIGN: Double blind, randomised, placebo controlled, crossover study. SETTING: Outpatients evaluated in an exercise test laboratory. PATIENTS: 15 patients with exercise induced myocardial ischaemia. INTERVENTIONS: Maximal cardiopulmonary exercise test on a treadmill according to an individualised ramp protocol on three days. The first day was used for adaptation to the equipment and to determine exercise tolerance and the presence of exercise induced ischaemia. On the other two days, the cardiopulmonary exercise test was performed two hours after oral administration of pyridostigmine (45 mg) or placebo. All patients were taking their usual medication during the experiments. MAIN OUTCOME MEASURES: Rate-pressure product and oxygen uptake during exercise. RESULTS:Pyridostigmine inhibited the submaximum chronotropic response (p = 0.001), delaying the onset of myocardial ischaemia, which occurred at a similar rate-pressure product (mean (SE) placebo 20.55 (1.08) mm Hg x beats/min 10(3); pyridostigmine 19.75 (1.28) mm Hg x beats/min 10(3); p = 0.27) but at a higher exercise intensity (oxygen consumption: placebo 18.6 (1.7) ml/kg/min; pyridostigmine 19.6 (1.8) ml/kg/min; p = 0.03). Also, pyridostigmine increased peak oxygen consumption (placebo 23.6 (2) ml/kg/min; pyridostigmine 24.8 (2) ml/kg/min; p = 0.01) and peak oxygen pulse (placebo 12.9 (1) ml/beat; pyridostigmine 13.6 (1) ml/beat; p = 0.02). CONCLUSIONS:Pyridostigmine improved peak exercise tolerance and inhibited the chronotropic response to submaximum exercise, increasing the intensity at which myocardial ischaemia occurred. These results suggest that pyridostigmine can protect against exercise induced myocardial ischaemia.
Authors: Marina T Durand; Christiane Becari; Mauro de Oliveira; Jussara M do Carmo; Carlos Alberto Aguiar Silva; Cibele M Prado; Rubens Fazan; Helio C Salgado Journal: PLoS One Date: 2014-08-18 Impact factor: 3.240
Authors: Marília Beatriz de Cuba; Marcus Paulo Ribeiro Machado; Thais Soares Farnesi; Angelica Cristina Alves; Livia Alves Martins; Lucas Felipe de Oliveira; Caroline Santos Capitelli; Camila Ferreira Leite; Marcos Vinícius Silva; Juliana Reis Machado; Henrique Borges Kappel; Helioswilton Sales de Campos; Luciano Paiva; Natália Lins da Silva Gomes; Ana Carolina Guimarães Faleiros; Constança Felicia de Paoli de Carvalho Britto; Wilson Savino; Otacílio Cruz Moreira; Virmondes Rodrigues; Nicola Montano; Eliane Lages-Silva; Luis Eduardo Ramirez; Valdo Jose Dias da Silva Journal: Mediators Inflamm Date: 2014-08-24 Impact factor: 4.711