Combination therapy with nicardipine and beta-adrenergic blockade for angina pectoris.

Nicardipine a second-generation dihidropyridine calcium antagonist, has been approved in oral formulation for use in the United States, and is under review for parenteral use. Nicardipine is the most vascular-selective agent of this class currently approved and should, on theoretical grounds, be ideal for combination therapy with beta-adrenergic blocking agents. Studies have shown that the combination of nicardipine and beta-blocking agents offers additional efficacy over monotherapy with either agent alone. The hemodynamic profile of combination therapy appears to be especially favorable in patients with diminished left ventricular function needing therapy with agents of both classes. Adverse effects are few and may be improved compared with other agents of the dihidropyridine class.     

A double-blind dose-response study of amlodipine in patients with stable angina pectoris

Sixty patients (31 male, 29 female) were studied in a 4-weekdouble-blind parallel dose-response study. Patients receivedamlodipine 1.25 mg (n = 12), 2.5 mg (n = 12), 5 mg (n = 12),10 mg (n=12) or placebo (n = 12) once a day. Anti-anginal efficacywas assessed by sequential treadmill testing 24 h post-dose,frequency of anginal attacks and consumption of nitroglycerin,patient and investigator assessment. In the analysis of thefinal vs baseline total exercise time, the difference betweenthose on amlodipine and those on placebo was significant (P<0.01),(all doses). Mean total exercise time increased by 24% in theamlodipine 10 mg group compared with a 20% decrease in the placebogroup. The time to onset of angina increased by 37% in the amlodipine10 mg group, compared with a 16.5% decrease in the placebo group.Differences were statistically significant for the 1.25, 5 and10 mg amlodipine groups vs placebo. ST-segment charges and rate-pressureproduct were not affected significantly. There was a statisticallysignificant difference in angina attack frequency and nitroglycerintablet consumption (P<0.05) for all dose groups vs placebo.The majority of patients receiving amlodipine reported improvementin angina symptoms. Side-effects were frequent but mild anddose-related. Amlodipine has significant anti-anginal efficacy.The mechanisms underlying the anti-ischaemic effects of amlodipineare still under discussion.     

Efficacy of the calcium antagonist isradipine in angina pectoris

Summary Thirty-six patients with chronic, stable angina pectoris were studied during 2-week treatment periods in which they received, in a randomized double-blind, crossover study, a new calcium entry blocking agent, isradipine, 7.5 mg three times daily or placebo. Antianginal efficacy was determined by treadmill exercise testing carried out 3 and 9 hours after drug administration on the final day of each treatment period. During placebo therapy, treadmill exercise time to the onset of angina (P₁) and to the development of moderate angina (P₂) was similar at 3 and 9 hours and similar to the placebo run-in period. During isradipine therapy, treadmill exercise time 3 hours after dosing was greater than with placebo therapy (P₁ 312±23.0 vs. 267±19.5 seconds,p<0.001; P₂ 410±20.2 vs. 355±18.8 seconds,p<0.002). Nine hours after drug administration, the results of exercise testing were similar to placebo.     

运动对心绞痛患者的康复作用

目的：观察运动对心绞痛患的康复作用。方法：48例心绞痛患被随机分为A，B两组，所有病例均接受心绞痛常规药物治疗，A组患同时进行运动训练，隔日1次，运动靶心率为该病人运动试验能达到的最大心率的75％－85％，运动持续时间30分钟左右；B组患采取自然生活。结果：随访1年，A组在心绞痛发作频率，持续时间，缺血性心电图，心功能改善方面均优于B组（P＜0．05）。A组运动期间未发生心肌梗死，猝死。结论：运动康复对心绞痛患安全有效，应大力提倡。     

曲美他嗪治疗冠状动脉粥样硬化性心脏病心绞痛的临床观察

目的观察曲美他嗪治疗冠状动脉粥样硬化性心脏病(CHD)心绞痛的临床疗效。方法冠心病心绞痛患者64例,随机分配到治疗组和对照组,两组在年龄、性别、心绞痛分型、合并病变及心功能分级分布均相仿。其中33例(治疗组)采用曲美他嗪20mgtid口服治疗,对照组31例不用曲美他嗪治疗,两组其他治疗冠心病心绞痛的方法、措施、药物均相同,观察两组心绞痛的发作频度、持续时间、硝酸甘油用量、心绞痛发作时心电图的心肌缺血情况等,并作疗效比较,2组疗程均为4周。结果两组均可显著降低心绞痛发作频率和硝酸甘油日耗量,并显著改善心电图ST-T,但是总的症状疗效、心电图疗效则治疗组优于对照组,治疗组心绞痛及心电图的总有效率分别为90.6%和71.9%,均显著高于对照组(54.8%和32.3%,P<0.05);治疗组在减少心绞痛症状、发作次数、持续时间、硝酸甘油用量、及改善心肌缺血的范围和程度等方面均显著优于对照组(P<0.05或P<0.01)。结论曲美他嗪治疗冠心病心绞痛疗效确切,在常规药物治疗的基础上,加用曲美他嗪可以进一步提高心绞痛的疗效。     

不稳定型心绞痛患者同型半胱氨酸内皮素及纤维蛋白肽A的变化及意义

目的 :探讨不稳定型心绞痛 (UAP)患者血中同型半胱氨酸 (Hcy)、内皮素 (ET)及纤维蛋白肽A(FPA)的变化及意义。方法 :分别测定UAP患者 (37例 )、正常人 (31例 )血中Hcy、ET及FPA值。结果 :UAP患者Hcy、ET及FPA值均明显高于正常人 [(12 .4 9± 5 .4 7)∶(4 .38± 1.14 ) μmol/L]、[(12 9.37± 2 6 .6 2 )∶(6 5 .0 6±13.76 )ng/L]及 [(8.87± 2 .11)∶(3.4 5± 0 .6 0 ) μg/L],均 P <0 .0 5 ,Hcy与ET呈正相关 (r =0 .4 5 ,P <0 .0 5 )。结论 :Hcy、ET及FPA的改变可能参与了UAP的病理生理过程     

Dilitiazem in Comparison with metoprolol in stable angina pectoris

The efficacy of diltiazem in comparison with metoprolol in chornicstable angina was asessted in 33 male patients during a 15-weekblind cross-over study. After an initial two-week run-in period,baseline measuremens were made. Subsequently,the patients enereda cross-over study consisting of two six-week treatment periodswith diltiazem 240 mg (60 mg q.i.d.)or metoprol 200 mg (100mg b.i.d.).Dose adjustment to either 360 mg diltiazem(120t.i.d.)or400 mg metoprolol(200b.i.d.)was allowed two weeks after thestart of treatment. There was a one-week washout period betweenthe two treatment periods. Compared to baseline values both drugs reduced the number ofanginal attacks (diltiazem –55%,p=0.02; metoprolol –73%,P=0.01)andshowed improvement of the measured exercise variables(exerciseduration; diltiazem +16%,P<0.001;meoprolol +4%,P=NS; timeto angina:diltiazem +21%,P=0.02,metoprolol + 14%, P =NS;maximalST-depression: diltiazem +13%,P =NS,metoprolol +33%,P=0.002).Nosignificant change in LVEF was noticed.Both drugs reduced themean heart rate on Holter tape (diltiazem–11%,P=0.006;metoprolol–14%, P=0.004). No effects on conduction were noticed. Although at the borderline of significance, diltiazem increasedthe total exercise duration as compared to metoprolol (16 vs,4%,P=0.05). It is concluded that diltiazem improves exercisetolerance in patients with stable angina pectoris and appearsto be a safe and effective alternative to the beta-blockingagent metoprolol.Our findings underscore the value of diltiazemas a monotherapeutic drug for the treatment of stable angina.     

心脏起搏术后患者发生心绞痛的情况分析

目的分析心脏起搏术后患者心绞痛的发生情况。方法 35例起搏器术后一年内并发心绞痛的为心绞痛组,选取同期的495例永久心脏起搏患者为非心绞痛组,比较两组的一般情况。并对不同起搏原因及不同起搏方式的心绞痛发作情况进行比较。结果与非心绞痛组比较,心绞痛组年龄、吸烟、性别构成无差异,但合并高血压、糖尿病、高脂血症比例较高。因房室传导阻滞(AVB)行心脏起搏者较因病窦综合征起搏者术后发生心绞痛比例高(15.4%vs 1.8%,P<0.001),而安置VVI者与DDD者心绞痛发生率相似(6.7%vs 6.3%,P>0.05)。结论起搏术后发生心绞痛患者多合并多种冠心病危险因素,AVB者术后心绞痛发生率高。     

Occurrence of angina pectoris prior to acute myocardial infarction and its relation to prognosis

In 917 patients with acute myocardial infarction (AMI) we evaluatedthe impact of previous angina pectoris on the prognosis. Thirty-fourpercent of the patients had chronic angina prior to AMI, and22% had angina pectoris of short duration. Patients with chronicangina pectoris differed from the remaining patients havinga more frequent previous history of AMI, diabetes mellitus,hypertension, and congestive heart failure. They less frequentlydeveloped a Q-wave AMI, and had smaller infarcts according tomaximum serum-enzyme activity as compared with the remainingpatients. They had a higher one-year mortality rate (36%) ascompared with those having angina pectoris of short duration(22%), and those with no angina pectoris (26%). Their reinfarctionrate was also higher (26%) as compared with that in the othertwo groups (15% and 9% respectively). In a multivariate analysisconsidering age, sex, clinical history, initial symptoms, initialelectrocardiogram and estimated infarct size, previous chronicangina pectoris was not an independent risk factor for death,but was independently associated with the risk of reinfarction(P<0.001) Among patients with a history of angina pectoristhe outcome was related to medication prior to onset of AMIand at discharge from hospital. Patients in whom beta-blockerswere prescribed at discharge had a one-year mortality of 13%as compared with 30% in the remaining patients (P<0.001).     

Time course of long-term placebo therapy effects in angina pectoris

A cohort of thirty-five patients with angina pectoris were followed-upfor six months with placebo as the only anti-anginal treatmentapart from short-acting nitroglycerin. Only patients with atleast five attacks per week were entered into the study. Priorto the study, their average number of attacks per week was 10.3(± 0.9) and their average nitroglycerin tablet consumptionper week was 10.6 (± 1.2). After admission into the study,the individual dosage of placebo could be blindly titrated duringthe first eight weeks. Once an adequate dosage was found, itwas continued for 6 months. The primary end-point was predefinedsuccess or failure of the placebo treatment. Failure was assessedon the lack of improvement, occurrence of ‘side-effects’,or need for other anti-anginal treatment. In 27 patients, theplacebo treatment was said to be a success (95% confidence limitsof the percentage of success: 60–90%). No severe cardiacevent occurred (confidence limits: 0–10%). Six patientsdeveloped ‘side-effects’. The number of attacksper week decreased by 48% (P<0.0001) during the titrationperiod (8 weeks) and by 77%> during the whole 6 months. Exercisetest improved, however, less markedly.     

A comparison of sustained release verapamil versus atenolol for 24 h protection from exercise-induced angina pectoris.

We have compared the efficacy of a once daily 360 mg sustained release preparation of verapamil (SRV) with that of once daily 100 mg atenolol in exercise-induced angina. The study was randomized, double-blind and cross-over in design involving 30 patients with chronic stable angina. A 2-week run-in placebo phase was followed by two 4-week periods of active treatment. Patients underwent exercise stress tests at 6 and 24 h post-dose at the end of each treatment phase. After the placebo phase, patients had significantly increased times to both 1 mm ST depression and angina at 6 h (afternoon stress test) compared to 24 h post-dose (morning test). The two treatments were found to be equivalent in terms of several indices of anti-anginal efficacy. The only significant differences between treatments were in relation to indices of heart rate, which were consistently lower with atenolol than with SRV. We conclude that once daily sustained release verapamil 360 mg has equivalent anti-anginal efficacy to once daily atenolol 100 mg. A lower angina threshold seems to occur in the morning in patients with ischaemic heart disease suggesting a diurnal variation.     

肌钙蛋白T检测对心绞痛预后的判断

目的 评价心肌肌钙蛋白T(cTnT)对心绞痛(AP)患者预后的判断价值。方法 采用酶联免疫吸附法(ELISA)动态测定77例心绞痛患者cTnT浓度,同时进行心肌磷酸肌酸激酶(CK)和磷酸肌酸激酶同功酶(CK—MB)测定。结果50例稳定性心绞痛(SAP)患者无1例血清cTnT异常升高,而27例不稳定性心绞痛(UAP)患者,11例血清cTnT异常升高,其中6人发展为急性心肌梗死。结论cTnT预测心绞痛患者预后的阳性预期值为54.5％,阴性预期值为100％。而CK—MB则相应为28.6％和80％,均低于血清cTnT。故在筛选UAP高危病人时,可通过血清cTnT增高加以区分。     

Amlodipine combined with beta blockade for chronic angina: results of a multicenter, placebo-controlled, randomized double-blind study.

Amlodipine, a potent long-acting dihydropyridine calcium antagonist, was compared with placebo in a parallel, randomized, double-blind study in 134 patients with chronic stable angina pectoris maintained on beta-adrenergic blocking agents. After a single-blind, two-week placebo period, patients were randomized to receive either amlodipine (2.5, 5, and 10 mg) or placebo once daily for four weeks. The effects of amlodipine on maximal exercise time, work, time to angina onset, and subjective indices including angina frequency, nitroglycerin tablet consumption, and patient and investigator ratings were assessed. Each dose of amlodipine produced increases in exercise time and calculated total work accomplished compared to baseline. Improvements at 5 and 10 mg were significantly greater than placebo which produced no significant change (p less than 0.05). Qualitative improvements in the severity of angina were produced by amlodipine at 5 and 10 mg daily assessed by patient-rating questionnaires (p less than 0.05). Reductions in angina frequency attacks per week and weekly nitroglycerin tablet consumption occurred but were not statistically significant when compared with placebo. Adverse effects observed during amlodipine treatment prompted discontinuation of treatment in only 2 out of 100 patients. Three patients discontinued treatment for reported lack of efficacy. No laboratory abnormalities prompted treatment discontinuation and minor side effects of dizziness, nausea, headache, and fatigue were observed infrequently. The results of this controlled, large-scale multicenter trial suggest that amlodipine significantly increased exercise capacity and was well tolerated when added to the antianginal regimen of patients remaining symptomatic while receiving beta-blocking agents.     

Effect of the addition of propranolol to therapy with nifedipine for unstable angina pectoris: a randomized, double-blind, placebo-controlled trial

The value of the addition of beta-blockers to coronary vasodilator therapy in the treatment of patients with unstable angina at rest is controversial. We conducted a double-blind, randomized, placebo-controlled 4 week trial of propranolol in 81 patients with unstable angina, 39 of whom were assigned to placebo and 42 of whom received propranolol in a dose of at least 160 mg daily. All patients were also treated with coronary vasodilators, including 80 mg nifedipine daily and long-acting nitrates. The incidences of cardiac death, myocardial infarction, and requirement for bypass surgery or coronary angioplasty did not differ between the two groups (propranolol = 16; placebo = 18). The propranolol group had a lower cumulative probability of experiencing recurrent resting angina than the placebo group (p = .013), and over the first 4 days of the trial the mean number of clinical episodes of angina (propranolol 0.9 +/- 0.2, placebo 1.8 +/- 0.3, p = .036), duration of angina (propranolol 15.1 +/- 4.3 min, placebo 38.1 +/- 8.4, p = .014), and nitroglycerin requirement (propranolol 1.1 +/- 0.3 tablets, placebo 3.5 +/- 0.8, p = .003) were also fewer. Continuous electrocardiographic recording for ischemic ST segment changes revealed fewer daily ischemic episodes in the propranolol group (2.0 +/- 0.5) than in the placebo group (3.8 +/- 0.7, p = .03), and a shorter duration of ischemia (propranolol 43 +/- 10 min, placebo 104 +/- 28 min, p = .039). Thus propranolol, in patients with unstable angina, in the presence of nitrates and nifedipine is not detrimental and reduces the frequency and duration of symptomatic and silent ischemic episodes.     

64排多层螺旋CT冠状动脉成像比较稳定性与不稳定性心绞痛患者冠状动脉粥样硬化斑块特征

目的 探讨64排多层螺旋CT冠状动脉成像比较稳定性心绞痛（SAP）与不稳定性心绞痛（UAP）患者粥样硬化斑块的特征.方法 对40例SAP患者、40例UAP患者进行64排多层螺旋CT冠状动脉成像,比较两组患者冠脉斑块的数量及斑块类型.对其中50例患者（26例UAP,24例SAP）罪犯斑块特征进行比较.结果 SAP组患者与UAP组患者斑块数量比较无显著性差异.UAP组患者非钙化性斑块、混合性斑块发生率较高.在对两组患者罪犯斑块特征进行比较的亚组分析中,UAP患者罪犯斑块非钙化性斑块、血管正性重构发生率以及血管重构指数明显高于SAP患者,在校正了年龄、性别、高血压病、糖尿病、高脂血症、吸烟等危险因素后,非钙化性斑块、血管正性重构与UAP显著相关.结论 64排多层螺旋CT冠状动脉成像显示：与SAP患者比较,UAP患者非钙化性斑块与混合性斑块发生率较高,罪犯斑块具有较高的非钙化性斑块及正性重构发生率.     

38例冠心病心绞痛的运动康复

目的：观察康复运动对冠心病心绞痛的疗效。方法：将38例劳累性稳定型心绞痛病人随机对等分为常规治疗组（Ⅰ组，19例），康复治疗组（Ⅱ组，19例），Ⅱ组除常规治疗外增加低运动强度的运动康复程序。结果：Ⅱ组住院日显著缩短，仅为Ⅰ组的一半，体力、回归工作也显著优于Ⅰ组。结论：康复运动可提高对心绞痛的疗效。     

骨桥蛋白对稳定型心绞痛患者危险分层的判断价值

目的探讨骨桥蛋白(OPN)对稳定型心绞痛患者危险分层的界值点及其意义。方法采用病例-病例研究,39例稳定型心绞痛患者入院时测定血浆OPN水平,观察6个月时发生不良心血管事件(心原性死亡、非致死性心肌梗死)的情况。应用受试者工作特征曲线(ROC曲线)确定OPN水平界值,根据该值将患者危险分层,分为高危组和低危组。结果血浆OPN水平危险分层的最佳界值取403ng/ml,其敏感性78.6%,特异性90.9%。高危组中发生不良心血管事件13例(76.5%),而无事件者为4例(23.5%);低危组中依次分别为5例(22.7%)和17例(77.3%)。高危组预后情况较低危组更差(76.5%和22.7%,P=0.001;RR3.365,95%CI1.490～7.597)。结论根据血浆OPN水平对稳定型心绞痛患者危险分层的最佳界值为403ng/ml,是较可靠的生化指标。     

早期应用普伐他汀治疗36例老年不稳定型心绞痛

目的探讨老年不稳定型心绞痛(unstableanginapectoris,UAP)病人早期(24～96小时)应用普伐他汀的疗效及安全性。方法临床确诊为UAP患者72例,随机分为对照组与普伐他汀组各36例,两组均用常规治疗,普伐他汀组加服普伐他汀,于治疗前及治疗后6和12个月时分别测肝功能、肾功能、肌酶谱、总胆固醇(totalcholesterol,TC)、低密度脂蛋白胆固醇(low鄄densitylipoproteincholesterol,LDL鄄C)、一氧化氮(nitricoxide,NO)、C鄄反应蛋白(C鄄reactiveprotein,CRP)、高密度脂蛋白胆固醇(high鄄densitylipoproteincholesterol,HDL鄄C),24小时动态心电图检测心肌缺血总负荷(totalischemicburden,TIB)和心血管缺血相关事件。结果普伐他汀6个月后能有效地降低UAP患者血清TC、LDL鄄C、CRP;升高NO,HLD鄄C;与对照组比较差异有统计学意义(P<0.01)。两组患者每周心绞痛发作次数及TIB均有减少,但普伐他汀组更明显(P<0.05);其缺血相关事件亦有显著性差异(P<0.01)。普伐他汀组中有3例轻度转氨酶升高,2例出现腹胀。结论UAP发病早期应用普伐他汀能安全、有效地降低血脂和CRP,升高NO,显著减少心血管缺血相关事件发生率。     

卡托普利治疗稳定劳力型心绞痛的临床效果

目的卡托普利在治疗稳定性劳力型心绞痛在临床治疗中的效果分析。方法选取2005年3月~2012年10月来我院进行治疗的稳定性劳力型心绞痛患者共200例,年龄为53~72岁,并随机分成两组观察组与对照组,每组各100例。对照组与观察组分别采用常规的治疗方法以及在常规治疗方法的基础上施以卡托普利治疗。其中,常规的治疗方法主要是采用β-受体阻滞剂,阿司匹林,硝酸酯类以及钙拮抗剂进行治疗。对两组的治疗情况进行观察与分析。结果在经过一段时间的临床应用治疗之后,观察组与对照组的稳定性劳力性心绞痛的治疗效果有着明显的改善,但是观察组的治疗效果明显优于对照组,观察组与对照组见的心率明显不一样,观察组慢于对照组。并且在运动过程中观察组的心绞痛病症诱发时间明显长于对照组。结论卡托普利在治疗稳定劳力型心绞痛病症的过程中有着显著的疗效,具有重要的临床意义。     

灯盏细辛注射液治疗冠心病心绞痛的Meta分析

目的评价灯盏细辛注射液治疗冠心病心绞痛的疗效。方法计算机检索Cochrane图书馆临床对照实验资料库、MEDLINE、EMbase、万方、维普、中国知网、中国生物医学文献数据库（CBM）,人工检索灯盏细辛注射液对冠心病心绞痛疗效的随机对照试验的相关文献,应用RevMan5．1软件对纳入文献数据进行Meta分析。结果共纳入9篇文献。Meta分析显示：实验组（常规治疗＋灯盏细辛注射液）治疗2周后总体疗效优于对照组（常规治疗）,差异有显著统计学意义（OR=2．74,95％CI：1．91—3．93,P〈O．01）：心电图改善总有效率及显效率亦显著优于对照组,差异有显著统计学意义（OR=2．38,95％CI：1．73。3．28,P〈0．01）。漏斗图近似对称,发表偏倚不大。结论灯盏细辛注射液治疗冠心病心绞痛在临床症状改善、心电图改善等方面疗效确切。但由于目前的临床研究质量整体较低,尚需进行严格的、多中心的随机双盲对照研究进一步证实。