曲美他嗪对稳定型心绞痛患者疗效及对运动耐量的影响

目的：探讨曲美他嗪对稳定型心绞痛患者疗效及对运动耐量的影响。方法回顾性分析我院2011～2013年心内科收治的300例稳定性心绞痛患者的资料,按照患者治疗方式分为观察组及对照组,各150例,两组患者均给予β受体阻滞剂、阿司匹林、氯吡格雷、钙通道拮抗剂、他汀类常规药物治疗,观察组加用曲美他嗪片,连续治疗2周,对患者进行运动耐量测定,对两组患者治疗后临床症状及运动耐量进行评价。结果观察组患者临床总有效率高,与对照组患者比较差异有统计学意义（P＜0.05）;观察组患者运动耐量观察指标改善明显,与对照组患者比较差异有统计学意义（P＜0.05）。结论曲美他嗪能改善心绞痛患者心肌能量代谢,减少患者心绞痛发作,提高运动耐量,效果满意。     

曲美他嗪联合麝香保心丸治疗不稳定型心绞痛疗效观察

目的：观察曲美他嗪联合麝香保心丸治疗不稳定型心绞痛的临床效果。方法将135例不稳定型心绞痛患者随机分为研究组（曲美他嗪与麝香保心丸联合应用）与对照1组（单用麝香保心丸）、对照2组（单用曲美他嗪）,分析比较各组临床疗效、心绞痛发作次数、硝酸甘油日耗量、心电图变化情况等。结果研究组总有效率高于对照1组和对照2组,差异均有统计学意义（P ＜0．05）。治疗前3组心绞痛发作频率、持续时间差异无统计学意义（P ＞0．05）。经治疗,研究组比对照1组、对照2组患者心绞痛发作频率、持续时间均明显降低,差异有统计学意义（P ＜0．05）。治疗前2组硝酸甘油耗量、24h 心肌缺血总时间、ST 差异无统计学意义（P ＞0．05）。治疗后2组硝酸甘油耗量、24h 心肌缺血总时间和 ST 均优于治疗前,且研究组优于对照1组和对照2组,差异有统计学意义（P ＜0．05）。结论曲美他嗪联合麝香保心丸治疗不稳定型心绞痛效果明显,值得临床推广应用。     

曲美他嗪治疗初发劳力型心绞痛的疗效观察

目的观察曲美他嗪治疗初发劳力型心绞痛的临床疗效。方法选择初发劳力型心绞痛60例，随机分为对照组和治疗组各30例。治疗组在对照组治疗的基础上加用曲美他嗪20mg3次，d。共4周。观察两组治疗期间心绞痛的发作次数及硝酸甘油消耗量，对两组治疗前后6min步行试验（6MWD）、超声心动图（UCG）和Holter进行评价。结果治疗组与对照组心绞痛发作次数和硝酸甘油消耗量比较差异有统计学意义（P〈0．005）。两组治疗前后自身比较左室射血分数（LVEF）、左室舒张末期容积指数（LVEDVI）、左室收缩末期容积指数（LVESVI）、6min步行试验和24h内心肌缺血次数差异均有统计学意义（P〈O．05或P〈0．005）；治疗后的两组间比较显示曲美他嗪进一步提高患者的6MWDI（P〈0．05）和LVEF（P〈0．05）。降低LVESVI（P〈0．05）、LVEDVI（P〈0．05）及24h内心肌缺血次数（P（0．05）；未出现不良反应。结论初发劳力型心绞痛患者常规药物联合曲美他嗪治疗，可减少心绞痛的发作次数和硝酸甘油消耗量。提高患者心功能，增加运动耐量。     

曲美他嗪治疗稳定型劳力性心绞痛患者疗效观察

目的 观察曲芙他嗪对稳定型劳力性心绞痛患者的疗效。方法 选择稳定型劳力性心绞痛患者80例，在使用传统抗心绞痛药物(β受体阻滞剂、钙离子拮抗剂、硝酸盐制剂)的基础上，加用曲芙他嗪20mg日3次，共12周。治疗前后行平板运动实验，观察用药前后下述指标的变化：①用药前后每周心绞痛发作次数，②每周硝酸甘油片的用量，③最大运动量时收缩压与心率的乘积，④动中心绞痛出现的时间，⑤运动诱发ST段下移0．1mv所需的时间，⑥运动持续时间。结果 患者每周心绞痛发作次数，硝酸甘油片的用量均明显下降（P＜0.05)，运动中心绞痛出现的时间及运动诱发ST段下移0．1mv所需时间明显延长(P＜0.05)，心率及心律和收缩压的乘积轻度变化(P＞0.05)。结论 曲芙他嗪能改善运动诱发的心肌缺血及心绞痛症状，对稳定型劳力性心绞痛患者有明显的疗效。     

曲美他嗪治疗稳定型心绞痛88例

目的评价曲美他嗪治疗稳定型心绞痛的疗效。方法稳定型心绞痛患者88例，常规服用传统抗心绞痛药物治疗基础上加服曲美他嗪20 mg，tid，比较治疗3个月前后临床指标及心脏运动试验。结果服用曲美他嗪3个月后患者心绞痛发作频率减少62.0%(P＜0.01)；舌下含服硝酸甘油用量减少68.0%(P＜0.01)，心绞痛CCSC分级明显改善(P＜0.01)；运动持续时间延长20.0%(P＜0.01)；运动总作功增加32.0%(P＜0.01)，运动至ST段下移1 mm的时间延长35.0%(P＜0.01)，运动至ST段压低的最大幅度减少24.0%(P＜0.01)，而静息和运动高峰时的心率、收缩压、率压积均没有明显变化(P＞0.05)。结论曲美他嗪可以使稳定型心绞痛患者的心绞痛症状缓解，运动耐量增加，缺血阈提高，生活质量改善，且对血流动力学没有影响，安全性好。     

曲美他嗪治疗冠心病临床研究

目的：观察曲美他嗪治疗冠心病的疗效。方法：将已确诊的冠心病107例随机分为两组，对照组采用常规治疗。治疗组在常规治疗的基础上加用曲美他嗪，服药1年观察心绞痛心脏危险事件发作频次，观察发作前后心电图的变化。结果：治疗组心绞痛发作频次显著低于对照组（P〈0．01），心脏危险事件发作频次明显低于对照组（P〈0．05），心电图改善明显优于对照组（P〈0．01）。结论：曲美他嗪治疗冠心病疗效肯定，值得在临床推广。     

曲美他嗪联合美托洛尔治疗稳定性心绞痛观察

目的 观察曲美他嗪联合美托洛尔对稳定性心绞痛患者的治疗作用。方法 对随机分组的30例研究对象在服美托洛尔基础上加服曲美他嗪治疗4周，进行心绞痛发作、动态心电图、运动试验评估，并与对照组作对比观察。结果 曲美他嗪组可减少心绞痛发作频率，缩短心绞痛持续时间，提高患者的运动耐受性（P〈0.05）。结论 曲美他嗪可通过代谢作用保护心肌缓解缺血，联合口受体滞剂有更好的抗心绞痛作用。     

曲美他嗪对冠心病（CHD）稳定性劳力型心绞痛患者心肌缺血的影响研究

目的：研究曲美他嗪对于冠心病稳定性劳力型心绞痛患者心肌缺血的影响。方法：以我院收治的120例冠心病稳定性劳力型心绞痛患者为研究对象,全部患者在1周内接受2次运动试验,结果显示两次试验结果均为阳性,运动的持续时间变异＜10%。在原来治疗方案的基础上,给予曲美他嗪治疗,对比分析治疗前后的运动持续时间、心绞痛发作次数、心率、心率与收缩压乘积等指标。结果：用药前与用药后对比,用药后,患者的心绞痛发作次数减少,运动持续时间、运动诱发心绞痛发作时间、ST段达到1mm的时间明显增加,P＜0.05;患者的心率、心率与收缩压的乘积差异不大,P＞0.05;全部患者用药治疗期间未出现明显不良反应,耐受性好。结论：对于冠心病稳定性劳力型心绞痛采用曲美他嗪治疗能增强患者的运动耐量,预防运动诱发的心绞痛、心肌缺血,提高生活质量,值得推广。     

氟桂嗪治疗偏头痛脑血流变化研究

目的：研究氟桂嗪治疗偏头痛脑血流的变化及疗效。方法：应用经颅多普勒超声仪（TCD）检测60例偏头痛患颅内动脉血流速度，并应用氟桂嗪治疗前后做自身对照。结果：TCD检测结果发现偏头痛患治疗前颅内动脉的平均血流速度（Vm)明显增快，与健康对照组比较有显性差异（P＜0．01），治疗势不两立在流速度明显减慢，与治疗前比较有显差异（P＜0．05），与健康对照组比较，除LMCA及RPCA（P＜0．05）外，其余均无显差异（P＞0．05），临床总有效率为88．33％，结论：氟桂嗪能改善偏头痛患颅内动脉的功能状态，疗效确切。     

左卡尼汀提高稳定型劳力性心绞痛病人运动耐量

目的 :比较左卡尼汀与曲美他嗪对心绞痛病人临床疗效及对运动耐量的影响。方法 :选择 6 0例冠心病稳定型心绞痛伴高脂血症病人 ,随机分为2组 ,分别予左卡尼汀 1.0 g ,po ,tid× 12wk及曲美他嗪 2 0mg ,po ,tid× 12wk ,比较每周心绞痛发作次数及硝酸甘油消耗量 ,运动耐量及血脂水平。结果 :左卡尼汀及曲美他嗪均减少心绞痛发作次数、硝酸甘油消耗量 ,运动至出现ST段压低 1mm所需时间、心绞痛所需时间、ST段缺血型下移之和明显减少 ,运动持续时间显著延长 ,左卡尼汀还降低总胆固醇、三酰甘油 ,升高高密度脂蛋白胆固醇。结论 :左卡尼汀及曲美他嗪均能缓解稳定型心绞痛病人症状 ,改善运动诱发的心肌缺血 ,提高运动耐量。左卡尼汀还可调节血脂水平     

Treatment of Stable Angina Pectoris with Trimetazidine Modified Release in Indian Primary-Care Practice

INTRODUCTION: In primary-care practice, trimetazidine is frequently used in combination with other antianginal drugs to enhance antianginal efficacy because of its metabolic mode of action. This study investigates whether a new twice-daily trimetazidine modified release formulation with improved pharmacokinetic properties is more effective and acceptable than the older thrice-daily immediate-release formulation. METHODS: In a multicenter prospective study, patients with uncontrolled stable angina pectoris receiving combination antianginal treatment that included the thrice-daily trimetazidine were identified. The immediate-release trimetazidine formulation was substituted with twice-daily trimetazidine modified release (Flavedon) MR), with no other changes in the treatment regimen. Follow-up was for 3 months. The primary outcomes were entirely clinical: frequency of anginal attacks and nitroglycerin (glyceryl trinitrate) consumption. RESULTS: In 279 patients, substitution of thrice-daily trimetazidine with twice-daily trimetazidine modified release reduced mean frequency of angina by four attacks per week (95% CI 3.1, 4.9; p < 0.01) and nitroglycerin consumption by 3.6 tablets per week (95% CI 2.9, 4.3; p < 0.01). The magnitude of these benefits was directly proportional to the number of antianginal drugs used in combination with trimetazidine. There were no withdrawals due to adverse effects, and daily compliance was 98%. CONCLUSION: The twice-daily trimetazidine modified release is more effective and acceptable than the thrice-daily formulation for the combination treatment of stable angina in primary-care practice.     

曲美他嗪联合地尔硫卓治疗心绞痛的疗效

目的观察曲美他嗪联合地尔硫卓治疗心绞痛的疗效。方法选取笔者所在医院心绞痛患者50例,随机分为治疗组和对照组。对照组给予休息、吸氧、镇静、抗凝和抗血小板聚集等常规抗心绞痛处理,治疗组在此基础上,给予口服曲美他嗪片和地尔硫卓片,治疗2周后观察疗效和心电图情况。结果治疗组总有效率88%,对照组总有效率64%,治疗组疗效明显高于对照组,差异有统计学意义(P<0.01)。两组心电图改变情况比较,治疗组总有效率72%,对照组总有效率52%,治疗组心电图改变情况明显优于对照组,差异有统计学意义(P<0.01)。治疗后,治疗组使用硝酸甘油情况明显较对照组少,差异有统计学意义(P<0.01)。两组均未发现皮疹等过敏反应,也未发现肝肾功能损害。结论在常规治疗心绞痛的基础上,使用曲美他嗪联合地尔硫卓片治疗心绞痛,能够取得满意效果,值得临床推广。     

曲美他嗪治疗稳定型心绞痛的疗效观察

目的:观察曲美他嗪辅助治疗稳定型心绞痛的疗效和安全性。方法:选择稳定型心绞痛患者110例,随机分为两组,对照组(52例)为常规心绞痛用药,曲美他嗪组(58例)在常规用药基础上加用曲美他嗪20mg,口服,每日3次,连续8周。结果:曲美他嗪组治疗总有效率高于对照组,差异有显著性(P<0.05);两组均无不良反应发生。结论:在常规药物治疗基础上加用曲美他嗪能更有效地缓解心绞痛,使运动耐量增加,且耐受性好,因此曲美他嗪是辅助治疗心绞痛安全、有效的药物。     

Assessment of Anti-Ischemic and Antianginal Effect at Trough Plasma Concentration and Safety of Trimetazidine MR 35mg in Patients with Stable Angina Pectoris

Objective

The study aimed to assess, at trough plasma concentration, the anti-ischemic and antianginal efficacy and tolerability of trimetazidine modified release (MR) 35mg taken twice daily by patients with stable angina pectoris.

Design

This multicenter, randomized, double-blind, placebo-controlled, international study started with a run-in period of 3 weeks with atenolol 50 mg/day and placebo, followed by a 6-month treatment period with once daily atenolol 50mg and twice daily trimetazidine MR 35mg or placebo.

Patients

The study involved 223 patients with stable angina pectoris (class II or III of the Canadian Cardiovascular Society [CCS] classification). 180 patients were analyzed in the full analysis set (FAS) following the intention to treat principle (ITT) and 167 patients were analyzed in the per protocol set (PPS). The PPS data are presented here.

Interventions

Two exercise tolerance tests (ETTs) were performed during the run-in period in order to assess the stability of exercise tolerance before angina pectoris and significant ST segment depression. Efficacy was assessed by a third ETT performed after 8 weeks of treatment, at trough, 12 hours after the intake of the drug. Safety was evaluated over the 6-month duration of the study.

Main outcomes measures

Time to 1mm ST segment depression.

Results

Time to 1mm ST segment depression was increased by 44 seconds more in the trimetazidine MR 35mg group than in the placebo group (p = 0.005). A significant difference was also evidenced for the time to onset of angina pectoris (p = 0.049) and for the reason for stopping the exercise (p = 0.02). No difference between groups was found for safety parameters.

Conclusion

This study demonstrates the anti-ischemic and antianginal efficacy of trimetazidine MR 35mg twice daily at trough plasma concentrations in patients with stable angina pectoris receiving atenolol 50 mg/day. Furthermore, the drug is well tolerated over 6 months.     

Antianginal Effects of Trimetazidine and Left Ventricular Function Improvement in Patients with Stable Angina Pectoris

Objective

To evaluate the effects of add-on treatment with trimetazidine, single dose and long-term, on clinical and objective parameters of ischemia in patients with stable angina pectoris receiving standard antianginal therapy.

Design

One-month single-blind, placebo-controlled study.

Patients

40 patients with stable angina pectoris.

Interventions

Patients received 1-month treatment with either trimetazidine 20mg (n = 20) or placebo (n = 20) 3 times daily in addition to standard antianginal therapy.

Main outcome measures

All patients underwent bicycle stress tests at baseline and at 1 month to assess exercise tolerance. Patients receiving trimetazidine also underwent a stress test 2 hours after administration of a 60mg single dose. Influence of trimetazidine on stress-induced left ventricular function was assessed in 11 patients, with dobutamine stress echocardiography performed at baseline and at 1 month. Clinical efficacy was evaluated in terms of mean weekly number of anginal episodes and weekly nitroglycerin (glyceryl trinitrate) tablet consumption during the study.

Results

Trimetazidine significantly improved most stress test parameters, after a single dose and after 1 month of treatment; the rate-pressure product remained unchanged. Dobutamine tests showed significant (p < 0.05) increases from baseline values in time to onset of anginal pain and threshold dobutamine dose (13.5 ± 0.7 versus 10.2 ± 0.8 min, and 43.6 ± 2.8 versus 35.4 ± 3.4 μg/kg/min, respectively). The severity of anginal pain and mean weekly number of anginal episodes was reduced significantly (p < 0.05) from baseline values after 1 months’ treatment with trimetazidine (1.3 ± 0.6 versus 2.3 ± 0.3, and 6.6 ± 1.4 versus 10.1 ± 1.3, respectively). After 1 month, weekly consumption of nitroglycerin tablets was decreased by 3.1 from baseline values in the trimetazidine group but increased by 0.3 in the placebo-treated group. No patient withdrew due to treatment-related adverse effects.

Conclusion

This study confirms the antianginal and anti-ischemic efficacy of single dose and long-term treatment with trimetazidine. Treatment with trimetazidine was well tolerated.     

Spotlight on Ranolazine in Chronic Stable Angina Pectoris

Ranolazine (Ranexa), a piperazine derivative, is a new antianginal agent approved for the treatment of chronic stable angina pectoris for use as combination therapy when angina is not adequately controlled with other antianginal agents. While the exact mechanism of action of ranolazine is not known, its antianginal and anti-ischemic effects do not appear to depend upon changes in BP or heart rate. An extended-release (ER) oral formulation of ranolazine has been developed to facilitate twice-daily administration whilst maintaining therapeutically effective plasma concentrations. In patients with chronic stable angina, ranolazine ER monotherapy was shown to improve exercise duration at trough plasma drug concentration in a dose-dependent manner compared with placebo. The drug was effective as adjunctive therapy in patients with chronic stable angina whose condition was not controlled adequately with conventional antianginal therapy. In randomized clinical trials, ranolazine ER was well tolerated, with no overt effects on cardiovascular hemodynamics or conduction, apart from a modest increase in corrected QT interval (but no torsades de pointes). Importantly, the efficacy and tolerability of ranolazine ER were not affected by old age and co-morbid conditions (heart failure or diabetes mellitus). Comparative trials of ranolazine ER with other antianginal agents and trials examining its effects on long-term morbidity and mortality in patients with ischemic heart disease are required to determine with greater certainty the place of the drug in current antianginal therapy. Nevertheless, ranolazine ER may well prove to be a useful alternative and adjunct to conventional hemodynamic antianginal therapy in the treatment of chronic stable angina.     

曲美他嗪治疗慢性肾衰竭合并冠心病稳定型心绞痛的临床疗效

目的:研究慢性肾衰竭患者合并冠心病稳定型心绞痛使用曲美他嗪治疗的临床疗效.方法:选取慢性肾衰竭合并冠心病稳定型心绞痛患者65例,分为曲美他嗪组与硝酸异山梨酯组,治疗4周.观察心绞痛发作次数、心率、血压、心电图、动态心电图变化.结果:曲美他嗪组与硝酸异山梨酯组治疗后明显减少心绞痛发作次数,临床症状改善,运动耐力增加,ECG运动试验,ST段下降1 mm时间延长,而两组对比差异无显著性.结论:曲美他嗪与硝酸异山梨酯治疗慢性肾衰竭合并冠心病稳定型心绞痛有相似疗效.     

Effect of Antianginal Drugs in Stable Angina on Predicted Mortality Risk after Surviving a Myocardial Infarction

Background

Although antianginal drugs are used over several months and through to years in stable angina, there is scant evidence regarding their influence on outcomes. The METRO (ManagEment of angina: a reTRospective cOhort) study sought to assess the independent effect of using these drugs on subsequent mortality risk in patients with stable angina.

Methods

Consecutive patients with stable angina, receiving at least one antianginal drug (nitrates, β-adrenoceptor antagonists, calcium channel antagonists, trimetazidine, or nicorandil), were selected if they were discharged alive from an intensive care unit following a myocardial infarction (MI). Their case-record data were used in a multivariate logistic regression model to examine the independent association of antianginal drug use prior to the MI with predicted post-discharge, 6-month, all-cause mortality risk.

Results

In 353 patients, of whom 287 (81.3%) were men, the mean (±SD) age was 55 (±10.2) years and duration of treated stable angina was 27.2 (±24.8) months. The odds ratios (95% CI) of 6-month, all-cause mortality after surviving an MI were: for treatment that included a β-adrenoceptor antagonist, 0.63 (0.26, 1.52; p = 0.309); a calcium channel antagonist, 0.76 (0.12, 2.89; p = 0.638); a nitrate, 0.52 (0.26, 1.05; p = 0.070); nicorandil, 0.62 (0.29, 1.33; p = 0.221); and trimetazidine, 0.36 (0.15, 0.86; p = 0.022).

Conclusion

The inclusion of trimetazidine in the antianginal treatment of stable angina is independently associated with a significant reduction in mortality after surviving an MI. This suggests that combining a metabolic agent with drugs that modulate oxygen supply and demand, early in the management of stable angina, may confer a survival benefit.     

A 6-week double-blind comparison of amlodipine and placebo in patients with stable exertional angina pectoris receiving concomitant beta-blocker therapy

This study was a multicenter, double-blind comparison of the antianginal efficacy and safety of amlodipine and placebo as adjunctive therapy with constant recommended maintenance doses of beta-blockers. Patients with stable exertional angina pectoris were randomized to placebo or amlodipine at a starting dose of 5 mg once daily. The amlodipine dose was adjusted to 10 mg daily after 2 weeks if angina attacks were not abolished. Antianginal efficacy was assessed throughout the study with angina diaries, investigators' and patients' global evaluations, and with bicycle exercise tests during a placebo run-in period (baseline) and after 2 and 6 weeks of double-blind treatment. On baseline-final analysis, the exercise time to angina onset increased by 13% with amlodipine compared to 6% with placebo (p < 0.05). The total exercise time increased by 11% on amlodipine compared with 2% on placebo, though this difference did not reach statistical significance. Angina attack frequency and nitroglycerin consumption were both reduced by adding amlodipine to beta-blocker treatment. Amlodipine in combination with beta-blocker therapy was well tolerated, with a low incidence of side effects and laboratory test abnormalities. The study showed clearly that addition of amlodipine to beta-blocker therapy in patients with stable angina pectoris was well tolerated and gave improved antianginal efficacy.