Evaluation of bepridil for the treatment of angina pectoris: Evidence for preservation of left ventricular function

The efficacy of bepridil (400 mg once a day) was assessed in 15 patients with exertional angina pectoris. All 15 patients reported substantial clinical improvement during bepridil treatment compared with placebo treatment. Episodes of angina were 11.8 ± 4.1 (mean ± standard error of the mean)/ week with placebo and 3.8 ± 1.6 with bepridil (p < 0.05); nitroglycerin use was 9.1 ± 3.3 tablets/ week with placebo and 3.5 ± 1.7 with bepridil (p < 0.05). Five of 15 patients receiving bepridil did not experience angina during treadmill exercise; in the remaining 10 patients, time to onset of angina during exercise was 5.7 ± 0.9 minutes with bepridil as opposed to 4.5 ± 0.8 minutes with placebo (p < 0.05). Left ventricular (LV) performance at peak exercise as measured by first-pass radionuclide angiography revealed the ejection fraction to be 38 ± 3% during placebo therapy and 47 ± 4% during bepridil therapy (p < 0.0025). End-diastolic LV volume was unchanged, but end-systolic volume was 136 ± 11 and 117 ± 13 ml (p < 0.05) and stroke volume was 82 ± 6 and 97 ± 9 ml (p < 0.05) during placebo and bepridil therapy, respectively. Heart rate at peak exercise was 136 ± 3 beats/min with placebo and 128 ± 3 beats/min with bepridil; however, blood pressure was unchanged. These studies demonstrate that bepridil results in significant clinical improvement and enhanced LV performance in patients with angina pectoris.