曲美他嗪对冠心病稳定性劳力型心绞痛患者心肌缺血的影响

目的探讨曲美他嗪对冠心病(CHD)稳定性劳力型心绞痛患者心肌缺血的影响.方法选择在1周内经2次运动试验结果为阳性,且运动持续时间变异低于10%的CHD稳定性劳力型心绞痛患者40例,在原有治疗不变的情况下,加用曲美他唪20mg每日3次,治疗12周.治疗前后均行平板运动试验,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的次数;(2)每周硝酸甘油片的用量;(3)心率及心率与收缩压的乘积;(4)运动诱发心绞痛发作所需的时间;(5)运动后ST段下降limn所需的时间;(6)运动持续时间;(7)总工作量.结果曲美他嗪应用12周后,患者每周心绞痛发作次数及硝酸甘油片的用量明显下降(P＜0.05),而对心率及心率与收缩压的乘积的影响无统计学显著意义(P＞0.05).与试验前相比,运动耐量和总工作量显著提高(P＜0.01),至心绞痛发作的时间及ST段下降1mm所需的时间均明显延长(P＜0.01).不良反应较少.结论曲美他嗪能增加CHD稳定性劳力型心绞痛患者的运动耐量,改善运动诱发心绞痛的心肌缺血,且安全有效,易于耐受.     

卡尼汀与曲美他嗪对稳定型劳力性心绞痛患者运动耐量的影响

目的　比较卡尼汀与曲美他嗪对稳定型劳力性心绞痛患者临床疗效及运动耐量的影响。方法　选择 6 0例经冠状动脉造影确诊冠心病稳定型心绞痛伴高脂血症患者 ,经随机分为两组 ,分别予卡尼汀及曲美他嗪治疗 12W ,比较平均每周心绞痛发作次数 ,每周硝酸甘油消耗量 ,平板运动试验检测运动耐量及血脂水平。结果　卡尼汀及曲美他嗪均使心绞痛发作次数、硝酸甘油消耗量明显减少(P <0 0 1) ,运动至出现ST段压低 1mm所需时间、运动至出现心绞痛所需时间、运动诱发ST段缺血型下移之和∑ST明显减少 ,运动持续时间显著延长 (P <0 0 5 ) ,卡尼汀还降低总胆固醇、甘油三酯分别为 17%和 15 % ,高密度脂蛋白升高14 % (P <0 0 5 )。结论　卡尼汀及曲美他嗪均有效缓减稳定型心绞痛患者临床症状 ,改善运动诱发的心肌缺血 ,提高运动耐量 ,疗效相同 ,卡尼汀还改善血脂。     

曲美他嗪治疗稳定型心绞痛疗效观察

将稳定型心绞痛（SAP）患者随机分成两组,对照组给予传统常规药物治疗;治疗组在此基础上加用曲美他嗪（TMZ）20mg口服,3次／d;疗程12周。观察两组治疗前后每周心绞痛发作次数、每周硝酸甘油用量、运动实验结果及安全性。结果治疗组每周心绞痛发作次数及硝酸甘油用量明显下降（P均〈0.01）,运动持续时间和总工作量显著提高（P均〈0.01）,运动中至心绞痛发作时间及ST段下降1mm的时间均明显延长（P均〈0.01）;心率与收缩压的乘积变化较小,无明显不良反应。认为在传统常规药物的基础上加用TMZ能明显改善SAP患者运动诱发的心肌缺血及心绞痛症状,且用药安全,患者易于耐受。     

曲美他嗪与辅酶Q_(10)治疗老年慢性稳定型心绞痛的临床观察

目的比较曲美他嗪与辅酶Q10对老年慢性稳定型心绞痛患者临床疗效及运动耐量的影响。方法选择70例诊断为慢性稳定型心绞痛老年患者,经随机分为两组,在原有规范的治疗上分别加用曲美他嗪片剂和治辅酶Q10疗8周,比较平均每周心绞痛发作次数,每周硝酸甘油消耗量,平板运动试验指标。结果曲美他嗪与辅酶Q10使心绞痛发作次数、硝酸甘油消耗量明显减少(P<0.05),运动至出现ST段压低1mm所需时间、运动至出现心绞痛所需时间显著延长(P<0.05),且曲美他嗪优于辅酶Q10(P<0.05)。结论曲美他嗪和辅酶Q10均有效缓减老年稳定型心绞痛患者临床症状,改善运动诱发的心肌缺血,提高运动耐量,曲美他嗪优于辅酶Q10。     

辅酶Q10对稳定型心绞痛患者运动耐量的影响

目的 研究辅酶Q10对稳定型心绞痛患者临床疗效及运动耐量的影响.方法 将205例稳定型心绞痛患者随机分为常规治疗组、辅酶Q10组和曲美他嗪组,治疗8 周后,比较各组心绞痛发作次数、每周硝酸甘油消耗量、平板运动试验指标.结果辅酶Q10组及曲美他嗪组心绞痛发作次数、硝酸甘油消耗量明显减少,运动至出现ST段压低1 mm所需时间、运动至出现心绞痛所需时间显著延长,做功负荷量明显增加,明显优于常规治疗组(P<0.05或P<0.01),且两者比较无统计学意义.结论 辅酶Q10与曲美他嗪均能有效缓解稳定型心绞痛患者临床症状,改善运动诱发的心肌缺血,提高运动耐量,但比较而言,辅酶Q10更为廉价.     

曲美他嗪对稳定性劳力型心绞痛患者运动耐量的影响

目的探讨曲美他嗪对稳定性劳力型心绞痛患者运动耐量的影响。方法 45例稳定性劳力型心绞痛患者随机分为A、B两组,A组常规治疗,B组在常规治疗基础上,加用曲美他嗪20 mg,3次/d,治疗30周。结果 B组患者每周心绞痛发作的次数较治疗前减少,运动诱发心绞痛发作所需时间较治疗前延长,运动后ST段下降≥1 mm所需时间较治疗前延长,缺血心肌摄取葡萄糖的能力较前改善（P均〈0.05）。结论曲美他嗪能提高稳定性劳力型心绞痛患者运动耐量和缺血心肌的摄糖能力,增加缺血心肌对葡萄糖的利用。     

曲美他嗪和美托洛尔对伴发糖尿病的稳定型心绞痛患者疗效比较

目的比较曲美他嗪和美托洛尔对伴发2型糖尿病的稳定型心绞痛患者的疗效差异。方法采用交叉设计,设曲美他嗪-美托洛尔(AB组)和美托洛尔-曲美他嗪(BA组)2种服药顺序组,曲美他嗪20mg,tid,8周,美托洛尔12.5mg,bid,8周,2种药物服用间期1周。分别记录2组用药前及用药8周心绞痛发作次数、硝酸甘油用量、运动平板心电图。结果综合交叉试验结果,心绞痛发作次数、硝酸甘油用量、ST段压低1mm的时间、ST段压低最大幅度4个参数显示曲美他嗪与美托洛尔同样减轻症状发作,提高运动耐量,两者疗效差异无统计学意义。结论曲美他嗪和美托洛尔均对伴发2型糖尿病的稳定型心绞痛患者有效。     

曲美他嗪辅助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临床效果。方法136例稳定型心绞痛患者被随机分成两组,对照组给予常规治疗;治疗组在给予常规治疗的基础上加服曲美他嗪片（20mg,每日3次）。连续治疗2个月。治疗结束后,记录两组患者心绞痛发作次数、硝酸甘油消耗量,进行运动试验,并观察不良反应。结果与对照组比较,治疗组总有效率升高（P〈0．05）,运动总时间、运动总作功、运动至ST段压低1mV的时间减少,运动至sT段压低的最大幅度明显增加（P〈0．05）,未见明显不良反应。结论曲美他嗪辅助治疗稳定型心绞痛安全、有效。     

曲美他嗪治疗不稳定性心绞痛50例临床观察

目的:评价曲美他嗪(TMZ)治疗不稳定性心绞痛疗效和耐受性。方法:50例不稳定性心绞痛患者被随机分为常规治疗组(24例)和曲美他嗪组(26例)。常规治疗组常规应用阿司匹林,β-阻滞剂,硝酸酯类药物和钙拮抗剂,曲美他嗪组在常规治疗基础上加用曲美他嗪20 mg,3次/d,治疗12周后对两组心绞痛发作情况和运动试验结果进行对比分析。结果:治疗12周后,和常规治疗组相比,曲美他嗪组心绞痛发作次数减少56%(P<0.01),硝酸甘油消耗量减少58%(P<0.01),心绞痛明显改善(P<0.01)。运动持续时间延长20%(P<0.01),运动总作功增加24%(P<0.01),运动至ST段下移1mm的时间延长23%(P<0.01);而静息和运动高峰时的心率,二项乘积(心率×收缩压)均没有明显变化(P>0.05),无显著不良反应。结论:曲美他嗪与其它药物联用对不稳定性心绞痛安全有效。     

曲美他嗪治疗稳定型心绞痛的有效性分析与研究

目的研究曲美他嗪治疗稳定型心绞痛的有效性。方法选取我院2014年1月~2016年5月收治的稳定型心绞痛患者60例作为研究对象,根据随机数字表法,将其分为传统组与曲美他嗪组,各30例。传统组采用常规药物治疗;曲美他嗪组增加曲美他嗪治疗。就两组患者治疗前后心绞痛发作情况、平板运动试验运动持续时间、硝酸甘油平均使用量和心绞痛治疗总有效率、药物并发症率进行比较。结果曲美他嗪组心绞痛治疗总有效率明显高于传统组(P0.05)。治疗前心绞痛发作情况、平板运动试验运动持续时间、硝酸甘油平均使用量比较,差异无统计学意义(P0.05);曲美他嗪组患者治疗后心绞痛发作情况、平板运动试验运动持续时间、硝酸甘油平均使用量均明显优于传统组(P0.05)。两组均仅有个别患者出现轻微腹痛、乏力和头痛,差异无统计学意义(P0.05)。结论曲美他嗪治疗稳定型心绞痛的有效性高,可有效控制心绞痛发作,改善心功能,减少硝酸甘油用量,且无明显副作用,安全性高,值得推广。     

杏丁注射液治疗稳定型心绞痛病人的疗效观察

目的评价杏丁联合用药在稳定型心绞痛治疗中的临床价值.方法选择经冠状动脉造影确诊为稳定型心绞痛66例病人,随机分为观察组及对照组各33例.观察组在给予基础治疗的同时,联合应用杏丁每日25 mL,静脉输注,15 d为1个疗程.对照组给予基础治疗.观察试验前后临床情况、活动平板试验及血液流变学指标变化,并对结果进行统计学分析.结果实验后,每周心绞痛发作次数及硝酸甘油片消耗量减少(P<0.01);心绞痛发作所需时间、运动持续时间、总工作量明显增加.结论杏丁注射液能够改善稳定型心绞痛病人的心肌缺血状态及血液流变学指标.     

Diltiazem: effects on exercise performance in patients with coronary artery disease

We evaluated a new slow-channel calcium-blocking agent, diltiazem hydrochloride, in 10 patients with documented fixed coronary artery disease who had reproducible angina and greater than or equal to 0.1 mV ST segment depression on ECG treadmill exercise testing after 1 week of single-blind placebo administration. Subsequently, over the next 6 weeks, either diltiazem (30 mg/tablet) or placebo were administered for 1 week each in a randomized double-blind triple crossover design, as one tablet four times a day, two tablets three times a day or two tablets four times a day, for a total diltiazem dose of 120, 180 and 240 mg/day, respectively. Treadmill (electrocardiogram) exercise testing was performed at the end of each week. Only diltiazem at 240 mg/day increased significantly the time to angina pectoris (P less than 0.05), time to ST segment depression (P = 0.01), time to maximal exercise (P less than 0.02), and heart rate at maximal exercise (P less than 0.05) without effecting significantly the maximal rate-pressure product compared to the corresponding placebo values. In addition, using only the diltiazem data, a significant high dose response was observed for time to angina (P less than 0.05), ST segment depression (P less than 0.005), and maximal exercise (P less than 0.025). No adverse reactions were reported during the study. Therefore, we conclude that 240 mg/day of diltiazem improves significantly exercise performance in patients with angina pectoris due to fixed coronary artery disease and adverse effects, rarely, if ever, occur at this dosage.     

心绞痛患者528次缺血性ST段下移分析

83例心绞痛患者经24小时动态心电图监测到528次缺血性ST段下移,分析结果表明:1.在心绞痛患者缺血性ST段下移中,无症状性心肌缺血占75％,发生次数是有症状的3倍;2.缺血性ST段下移,85％与活动有关;3.缺血性ST段下移有明显的昼夜分布规律,上午6—10时为发作高峰,占全天总次数32％。提示在冠心病治疗中应重视包括无症状性心肌缺血在内的总缺血负荷,并结合缺血的昼夜分布规律调整给药时间。     

X syndrome--report of six cases]

Six patients (2 males and 4 females, mean age of 46 years) with X syndrome were reported in this paper. All patients presented with typical exertional angina pectoris. In 4 patients the angina had a variable threshold of onset, it often occurred at rest and occasionally nocturnally. The electrocardiogram during chest pain showed ST segment depression of more than 0.05-0.1 mV in all 6 patients. The treadmill or bicycle ergometer exercise test was positive in 4 cases (ST segment depression > 0.1 mV), equivocal in 1 (ST segment < 0.1 mV) in whom the 201Tl exercise myocardial perfusion scan showed sign of ischemia, and negative in 1 in whom atrial pacing at heart rate of 135 beats/min induced angina and ST segment depression of 0.1-0.15 mV. Echocardiograms and X ray chest films revealed no sign of ventricular hypertrophy or enlargement. The 201Tl exercise myocardial perfusion scan was performed in 5 patients, which showed signs of ischemia in 4 patients and suspected to have ischemia in 1. Left ventriculograms and coronary angiograms were normal in all 6 patients. Ergonovine provoking test (total dose of 0.4 mg) was negative in 5 patients, it was not performed in 1 in whom there was no evidence of coronary artery spasm by angiogram during appearance of electrocardiographic ischemic changes and chest pain. Left ventricular endomyocardial biopsy was performed in 1 patient, which showed significant smooth muscle cell proliferation in the medial layer of a small artery with diameter of 62.5 mu which produced narrowing of the lumen.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical studies with transdermal nitroglycerin

The short- and long-term effects of various Nitro-Dur formulations on performance and hemodynamics were studied in 15 men with stable angina pectoris who also had a positive treadmill exercise test. A treadmill exercise score (TES) was used that quantified the “ischemic” ST segment response to exercise. The score incorporated information that reflected the rapidity of evolution of ST segment depression during exercise and the time required for it to resolve after cessation of exercise. In early tests (n = 10) Nitro-Dur improved both the TES (by 31%: p < 0.0001) and the time required for 1 mm ST segment depression (by 33%: p < 0.0001). At all dosage levels, Nitro-Dur also decreased resting systolic blood pressure and increased resting heart rate. No dose-response patterns emerged. Changes in TES and time to ST segment depression were greater with sublingual nitroglycerin than they were with Nitro-Dur. In tests conducted after prolonged dosage (n = 5), the effects of Nitro-Dur on blood pressure and heart rate became attenuated at weeks 2 and 4, although cardiac responsiveness was preserved, as reflected in the increased time required before the occurrence of 1 mm ST segment depression. The latter effect was also observed with sublingual nitroglycerin. The clinical relevance of these data to the design of individual patient therapy is discussed.     

Effect of bepridil in patients with chronic stable angina: results of a multicenter trial

The effects of bepridil, a calcium antagonist with a half-life of approximately 42 hr, were assessed in a double-blind, randomized, placebo-controlled crossover trial. Forty-four patients (39 men, five women) with exercise-induced angina pectoris and ST segment depression with exercise testing (modified Bruce protocol) were studied. Compared with placebo bepridil (400 mg daily) increased total exercise time, time to onset of angina, time to 1 mm of ST segment depression, time to 2 mm of ST segment depression, and total work achieved (all p less than or equal to .001). Both frequency of angina and nitroglycerin consumption decreased during the bepridil compared with the placebo period (p = .02 and .03, respectively). Minor side effects were noted during both the bepridil and placebo phases. Four patients experienced side effects that limited therapy (dizziness in three and abnormal results of liver function tests in one) and one patient died during the bepridil phase. This study suggests that bepridil, 400 mg daily, is effective for the treatment of exercise-induced myocardial ischemia and angina pectoris.     

重复运动试验的心肌缺血预适应作用的研究

目的观察运动试验诱发的心肌缺血能否减轻随后运动试验引起的心肌缺血的严重程度及降低心律失常的发生率。方法稳定型劳力性心绞痛患者40例,依序进行两次平板运动试验。两次运动量相同,两次运动间隔12 m in。对比两次ST段压低1 mm出现时间(1 mm STD时间);ST段压低大于1mm持续时间(总缺血时间);ST段压低最大程度(最大STD);ST段恢复1 mm的时间(1 mm恢复时间);表现缺血的导联数(1 mm STD导联数);心律失常及心绞痛发生情况。结果与第1次运动试验相比,第2次运动试验的1 mm STD时间从490 s延长到620 s(P<0.001);总缺血时间从510 s减少到350 s(P<0.001);最大STD从3.1 mm降至1.2 mm,两次比较差异有显著性(P<0.001);1 mm恢复时间从420 s缩短到180 s(P<0.001);1 mm STD导联数从4.2个减少到2.3个(P<0.01)。40例患者中35例首次运动中发作心绞痛,其中30例再次运动中症状明显减轻,5例未发作心绞痛。第1次运动试验后心律失常的发生率62.5%(25例),而第2次运动试验后心律失常的发生率为20%(8例)。结论重复运动试验作为临床心肌缺血预适应的方法可提高稳定型劳力性心绞痛患者的缺血阈值,增强心肌对缺氧的耐受,减轻心肌损伤程度,降低心律失常的发生率。     

The effect of trimetazidine in the treatment of microvascular angina

Although the pathophysiology of microvascular angina is unclear, intracellular metabolic changes are believed to be the main factors. Trimetazidine has an intracellular metabolic effect in coronary insufficiency. The effect of trimetazidine in microvascular angina is unknown. Thirty-five patients (8 men, 27 women, age 36–57 years, mean 43.9±6.4 years) with microvascular angina were included in this study. The effects of trimetazidine (60 mg daily) were investigated in a placebo-controlled, doubleblind study consisting of two 4-week treatment periods. Patients were assessed by symptom-limited exercise testing (Bruce protocol). Heart rate and systolic blood pressure at rest, peak exercise, and the time of 1 mm ST segment depression were not significantly different between placebo and trimetazidine treatment. Trimetazidine prolonged total exercise time and time to 1 mm ST depression compared with placebo. Maximum ST depression was less in patients with trimetazidine therapy than those with placebo. It is concluded that trimetazidine has a beneficial effect in cases with microvascular angina.Presented in part at the 39th Annual World Congress, International College of Angiology, Istanbul, Turkey, June 1997     

The threshold for myocardial ischemia varies in patients with coronary artery disease depending on the exercise protocol

It is generally accepted that angina pectoris and, presumably, myocardial ischemia occur at a fixed heart rate-systolic blood pressure product in a given patient. This concept of a fixed threshold has recently been challenged. To evaluate the effects of varying exercise intensity on the ischemic threshold, 33 patients with coronary artery disease and provokable myocardial ischemia, documented by thallium-201 myocardial perfusion imaging, underwent two exercise tests 2 to 7 days apart. A symptom-limited incremental treadmill exercise test was followed by a 20 min submaximal treadmill test at an intensity approximating 70% of the peak heart rate attained during the incremental test. During the incremental exercise test, angina pectoris developed in 16 patients and 17 patients were asymptomatic. At least 0.1 mV of ST segment depression developed in all subjects during the incremental exercise test at a mean exercise duration of 5.3 +/- 2.6 min, a rate-pressure product of 19,130 +/- 5,735 and oxygen uptake of 19.6 +/- 7.0 ml/kg per min. During the submaximal exercise test, 28 (85%) of the 33 patients had significant ST segment depression. Of these patients, 24 (86%) were asymptomatic, including 10 patients who had previously reported anginal symptoms during the incremental test. The average time to onset of 0.1 mV ST segment depression during the submaximal test was 8.1 +/- 4.5 min. These changes occurred at a rate-pressure product of 15,250 +/- 3,705 and an oxygen uptake of 14.3 +/- 5.9 ml/kg per min, and were significantly (p less than 0.001) lower than values observed during the graded exercise.(ABSTRACT TRUNCATED AT 250 WORDS)     

Myocardial ischemia during daily activities: the importance of increased myocardial oxygen demand

The role of increased myocardial oxygen demand in the pathophysiology of myocardial ischemia occurring during daily activities was evaluated in 50 patients with coronary artery disease and exercise-induced ST segment depression. Each patient underwent ambulatory electrocardiographic (ECG) monitoring for ST segment shifts during normal daily activities and symptom-limited bicycle exercise testing with continuous ECG monitoring. All 50 patients had ST depression greater than or equal to 0.1 mV during exercise. A total of 241 episodes of ST depression were noted in the ambulatory setting in 31 patients; only 6% of these were accompanied by angina pectoris. Significant (0.1 mV) ST depression during ambulatory monitoring was preceded by a mean increase in heart rate of 27 +/- 12 beats/min. Patients with ischemia during daily activities developed ST depression earlier during exercise (7.9 +/- 4.4 vs. 14.2 +/- 6.4 min, p less than 0.001) and tended to have significant ECG changes at a lower exercise heart rate and rate-pressure product than did those without ST depression during ambulatory monitoring. In the 31 patients with ischemia during daily activities, the mean heart rate associated with ST depression in the ambulatory setting was closely correlated with the heart rate precipitating ECG changes during exercise testing (r = 0.74, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)