Antianginal Effects Research Articles

The possibilities of using beta-blocker bisoprolol in patients with stable angina with concomitant bronchial asthma.

Aim To compare efficacy and safety of treatments with the calcium antagonist (CA) verapamil, the cardioselective β-blocker (BB) bisoprolol, and a combination therapy with bisoprolol and amlodipine in patients with stable angina (SA) with concurrent mild and moderate, persistent bronchial asthma (BA).Material and methods This open, prospective, randomized, comparative study included 120 patients with an IHD+BA comorbidity. Of these patients, 60 had mild persistent BA and 60 had moderate persistent BA. Each group was divided into 3 subgroup, each including 20 patients, based on the used regimen of antianginal therapy. Stepwise dose titration was performed every 2 weeks (subgroup 1 received the BB bisoprolol 2.5 mg - 5 mg - 10 mg; subgroup 2 received the CA verapamil 240 mg - 240 mg - 240 mg; subgroup 3 received bisoprolol 2.5 mg followed by the combination treatment with bisoprolol and amlodipine as a fixed combination 5+5 mg). All patients underwent a complete clinical and instrumental examination at baseline and at 2, 4, and 6 weeks of treatment. The antianginal effectivity and the effect on bronchial patency were evaluated.Results In patients with SA and mild persistent BA, the study of external respiration function (ERF) at 2, 4, and 6 weeks of treatment did not detect any significant difference in the forced expiratory volume in 1 second (FEV1) between the treatment subgroups. In patients with SA and moderate persistent BA receiving the treatment, a significant decrease in FEV1 (р=0.022) was observed in subgroup 1 receiving bisoprolol 10 mg at 6 weeks of treatment. In subgroups 2 and 3 during the treatment, significant differences were absent. In patients with SA and mild or moderate persistent BA, the heart rate was significantly decreased in all three subgroups; however, in subgroup 2 receiving verapamil, the changes were considerably smaller than in other subgroups.Conclusion The study results showed that the BB bisoprolol with dose titration every two weeks from 2.5 to 10 mg or the combination treatment with the BB bisoprolol and the CA amlodipine can be used as the antianginal therapy in patients with SA and mild persistent BA. The BB bisoprolol may be used in patients with SA and moderate persistent BA as the antianginal therapy, but only at doses not exceeding 5 mg to avoid the development of bronchial obstruction. The combination therapy with the BB bisoprolol 5 mg and the CA amlodipine 5 mg is indicated to enhance antianginal and vasoprotective effects.

Ефективність фіксованої подвійної комбінації бісопрололу і периндоприлу в пацієнтів зі стабільною ішемічною хворобою серця та артеріальною гіпертензією різного ступеня

The aim – to evaluate the hypotensive and antianginal efficacy of a fixed double combination (bisoprolol, perindopril) in patients with coronary artery disease (CAD) and concomitant hypertension.Materials and methods. The study involved 170 cardiologists from various regions of Ukraine. Each researcher selected 15 consecutive outpatients with coronary heart disease who came for a regular visit. Inclusion criteria: age over 18 years old, blood pressure (BP) above 140/90 mm Hg, heart rate (HR) above 60 bpm, bisoprolol as part of antihypertensive therapy in the last ≥ 3 months. The study included two visits. At each visit, the patient’s objective status was assessed; an individual questionnaire with office systolic and diastolic blood pressure, heart rate, ECG data, clinical manifestations of CAD, risk factors, lifestyle features, concomitant diseases, current therapy was filled out. Medication adherence was also evaluated, the therapy was corrected if necessary and the presence of side effects and adverse events was registered. We analyzed the levels of BP and HR at the beginning and at the end of the study, the percentage of achievement of the recommended levels of these indicators, the antianginal efficacy of treatment and adherence to therapy in patients with CAD and different degrees of hypertension after 4 weeks of treatment.Results and discussion. 2785 patient questionnaires were provided by doctors, 1747 patients were included in substudy. The mean age of the patients was 60.9±10.2 years old, men – 57.1 %, women – 42.9 %. The diagnosis of coronary artery disease was based on: chest pain – 554 (31.7 %), a history of documented myocardial infarction – 935 (53.5 %), coronary ventriculography – 536 (30.7 %), revascularization (CABG/stenting) – 344 (19.8 %) patients. The use of a fixed combination of previously taken drugs (perindopril, bisoprolol) for 4 weeks allows to reduce heart rate and blood pressure effectively (HR ≤ 70 bpm reached 84.9 % of patients, BP ≤ 140/90 mm Hg – 86.9 %), to reduce the number of angina attacks (from 4.48, 4.5 and 4.7 per week at the beginning of the study to 2.4; 2.9 and 2.3 per week in patients with 1, 2 and 3 degrees of hypertension, respectively) and the need for nitroglycerin from from 4.5; 4.9 and 5.9 tab per week up to 2.4; 2.9 and 2.3 tab per week. The most significant absolute decrease of BP and HR was in patients with a more severe degree of hypertension (decrease systolic BP was – 40.8 mm Hg, diastolic BP – 21.4 mm Hg, HR – 21.8 bpm).Conclusions. The study demonstrated that the use of the fixed combination of bisoprolol and perindopril in patients with coronary artery disease and concomitant hypertension (different degrees) helps to improve treatment efficacy, to achieve recommended levels of blood pressure and heart rate, also has a significant antianginal effect (reliable decrease of the number of angina attacks and the need to take nitroglycerin) and increases adherence to therapy.

Подходы к выбору антиангинальной терапии у больных с сахарным диабетом 2 типа

The purpose — to study the efficacy and tolerability of different classes of antianginal drugs in patients with chronic coronary artery disease with DM2 having stable angina pectoris syndrome. Material and methods. 104 patients (m/w 59/45, average age — 64.7 (11.1) years) with DM2 and with stable angina pectoris were under observation. All patients received adequate hypoglycemic, vaso- and cardioprotective therapy. All patients were prescribed antianginal agents in various combinations: β-AB — in 32 (30.8%) cases, calcium channel blockers — in 30 (28.8%), ivabradine — in 29 (27.9%), ranolazine — in 25 (24.0%), nitrates — in 22 (21.2%), trimetazidine — in 38 (36.5%), and meldonium — in 34 (32.7%) cases. Before the start of follow-up and after 16 weeks of treatment the angina pectoris class and standard clinical and biochemical parameters were evaluated, echocardiographic examination, Holter monitoring of an electrocardiogram, a test with reactive hyperemia were performed. Results. The treatment provided a rapid, distinct and stable antianginal effect. Thus, the average levels of angina pectoris decreased from 2.37 (0.4) to 1.19 (0.1), p < 0.05. A significant decrease in clinical manifestations of angina pectoris was achieved after 2 weeks from the start of treatment in 72 (69.2%), and after 4 weeks — in 93 (89.4%) people. A reliable relationship between the higher antianginal efficacy of treatment and some clinical and laboratory features of patients was revealed. Conclusions. In individuals with stable angina and DM2, adequate use of antianginal drugs provides a rapid and stable decrease in the severity of angina.

Effects of dipyridamole and its use in neurology

Dipyridamole has been on the pharmaceutical market since 1959 and, as a pyrimidyl-pyrimidine compound, has a variety of mechanisms of action. The very first action of dipyridamole was its antianginal effect. In subsequent years, attention was drawn to the antiplatelet properties of dipyridamole, which are related to inhibition of platelet phosphodiesterase as well as to blocking adenosine transport. Another important property of dipyridamole is its effect on the deformability of red blood cells, thereby improving microcirculation. Dipyridamole affects changes in the dynamics of platelet activity and vascular reactivity and causes improvement of cerebral perfusion. Due to its pronounced antiplatelet properties, the drug has been widely studied for the prevention of ischemic strokes and transient ischemic attacks, both as monotherapy and in combination with other drugs. Unlike other platelet antiaggregants, dipyridamole does not have a damaging effect on mucous membranes. Its antiplatelet effect is not accompanied with inhibition of cyclooxygenase activity and reduction of prostacyclin synthesis. In the treatment of cerebral circulation disorders, dipyridamole can be used to control the antithrombotic effect by selecting the optimal dose of the drug. Dipyridamole has antioxidant properties, enhances NO-mediated pathways, has indirect anti-inflammatory effects via adenosine and prostaglandin-2 as well as direct anti-inflammatory effects and several other effects. Dipyridamole is considered a safe drug based on decades of clinical experience. Its side effects are usually limited and transient. Given the diverse effects of dipyridamole, it can be used for a wide range of pathologies other than thrombosis prevention. Data on the efficacy and safety of dipyridamole in various diseases of the neurological spectrum are presented.

Anti-ischemic effect and cardiodynamic changes under low-intensive laser irradiation compared to the obsidan effect in patients with angina pectoris

Purpose: to estimate the anti-anginal effect and to assess changes in hemodynamic parameters in patients with angina pectoris (AP) under low-intensive laser irradiation and to compare them with those under Obsidan preparation administration.Materials and methods. 70 males with AP of functional class I–IV were enrolled in the study and randomized into 2 equivalent groups: Group 1 – patients who took Obsidan; Group 2 — patients who were treated with infrared laser light. Patients were examined at the initial stage-one hour after 40 mg Obsidan take (Group 1), and one month after 10-day course of laser therapy (LT) (Group 2). All patients had echocardiography and cycle ergometric test.Results. The performed examinations showed a statistically significant increase in exercise tolerance in patients of LT group and Obsidan group by 35.0% and 34.1%, respectively. It should be noted that echocardiographic indicators had unidirectional, statistically significant shifts characterized by improvements in the myocardial inotropic function: decrease in the end-systolic volume by 17.9% and 18.8%, increase in the left ventricular ejection fraction from 50.3 ± 6.2 to 55.7 ± 5.8% and from 46.3 ± 4.3 to 50.1 ± 6.1 after LT and Obsidan , respectively. The optimal diastolic cardiac function was confirmed by the reduced time of myocardium isometric relaxation from 112.9 ± 24.3 to 94.3 ± 25.3 ms (p=0.012) under LT and from 110.3 ± 22.7 to 97.3 ± 19.3 ms under Obsidan (p=0.012). Results of the exercise tolerance test indicated the activation of cardiac economy mechanisms in both groups.Conclusion. Low-intensive LT had an impact at the cardiac activity similar to that of Obsidan. Moreover, it also has the equal anti-ischemic effect what may be explained by the decrease of energy expenditure during physical activity in patients with AP.

Choosing an antianginal therapy strategy in patients with stable coronary artery disease in real clinical practice: the advantages of trimetazidine

Cardiovascular diseases (CVD) are the leading cause of death among adults worldwide, including in the Russian Federation. At the same time, the leading position in the structure of causes of death from CVD is occupied by coronary heart disease (CHD) (16% of the total number of deaths in the world per year). The new clinical guidelines of the Ministry of Health of the Russian Federation for the management of patients with stable coronary heart disease in 2020 identify two main goals of conservative therapy – the elimination of symptoms of the disease and the prevention of cardiovascular complications (CVD). In this connection, when choosing antianginal therapy in patients with stable angina, it is necessary to consider the possibility of using combinations of both first-line and second-line drugs in order to really improve the effectiveness of treatment and achieve the goals set. It is advisable and justified to use more widely 2-line drugs, in particular trimetazidine, at any stage of therapy to enhance the antianginal effectiveness of b-blockers, calcium antagonists and prolonged-acting nitrates, especially in patients with hemodynamic features (arterial hypotension, rhythm and conduction disorders), which is demonstrated in the given clinical example. The effective addition of tremetazidine to the arsenal of traditional antianginal drugs is legislated in practice and is reflected in the new clinical recommendations of the Ministry of Health of the Russian Federation in 2020. The accumulated experience of using trimetazidine allows a pathogenetically sound approach to the treatment of stable CHD, restoring the balance between the need and delivery of oxygen to the heart muscle, and the safety profile expands the possibilities of use in patients with comorbid pathology.

The role of flavonoids in the prevention and management of cardiovascular complications: a narrative review.

Cardiovascular diseases (CVDs) are the world's leading cause of death, affecting an estimated 17.9 million people. CVDs have been the primary risk factor for mortality in developed countries. Smoking, hypertension, diabetes, abdominal obesity, psychological stressors, insufficient vegetable and fruit intake could significantly alleviate the burden of disease. The present review sought to document the anti-hypertensive, anti-arrhythmic, anti-anginal, and anti-infarction effects of flavonoids. Cardiovascular disorders are the leading cause of death worldwide, affecting an estimated 17.9 million individuals. Strokes and heart attacks account for 4 out of every 5 deaths caused by cardiovascular disorders. Physical activity protects against a variety of chronic conditions at any age. A demographic program combined with a high-risk CVD prevention approach could dramatically minimize the disease burden in the coming years. By controlling weight and improving the body's use of insulin, physical activity decreases the risk of CVDs. Tobacco and smoking are other modifiable factors associated with the progression of cardiovascular disorders. Abnormal blood lipids are also linked to dietary habits. Daily flavonoid consumption is linked to a lower risk of heart disease. Flavonoids have been the subject of significant interest by experts in recent times due to wide spectrum of possible benefits they provide. polyphenolic compounds can be useful as adjunctive therapy for the management and cure of inflammatory diseases. Literature related to cardiovascular effects of flavonoids was assessed on important database like PubMed, Scopus, ScienceDirect. The outcomes of various studies were documented. Flavonoids are fairly soluble in physiological media and thus are a potential candidate for the possible management of cardiovascular and associated disorders. Alleviating the oxidative stress induced by reactive oxygen species using anti-oxidant-rich flavonoids could lower the chances of platelet hyperactivation, heart disease, discomfort, and fibrosis. Flavonoid intake on a daily basis has been linked to a lower risk of heart failure. Polyphenolic compounds have the ability to be used as an adjunctive therapy in the prevention and control of cardiovascular and inflammatory diseases. Flavonoids have a role in the management of coagulation disorders.

EFFECTIVENESS OF THE COMBINATION OF TRIMETAZIDINE AND BISOPROLOL IN PATIENTS WITH ANGINA PECTORIS: A POST-HOC ANALYSIS OF CHOICE-2 STUDY

Objective: Objectives. To evaluate the effectiveness of the combination of trimetazidine (TMZ) and bisoprolol in angina patients in real-world clinical practice. Design and method: Methods. This is a post-hoc analysis of CHOICE II, a Russian, multicenter, 6-month, open-label, prospective observational study that assessed the effect of adding TMZ modified release 35 mg bid to antianginal treatment. 896 patients with persistent symptomatic stable angina were included in CHOICE-II, of whom 221 receiving TMZ -bisoprolol were included in the post-hoc analysis. Patients took TMZ 35 mg bid for the entire study duration. There was no optimization of other antianginal drugs. Results: Results. The mean age of patients was 64.8 ± 8.9 years. 52.0% were female. 91.9% had hypertension. Mean heart rate was 71.9 ± 9.6 beats per minute. At baseline patients had stable angina, mostly with CCS Class II (65.6%) or Class III (30.8%). Both angina frequency and short-acting nitrate (SAN) use decreased significantly on TMZ-bisoprolol from baseline to month 6 from 6.2 ± 5.3 to 1.5 ± 1.9 attacks/week and from 5.5 ± 4.4 to 1.0 ± 1.4 SAN/week, respectively (P < 0.001 for both). Exercise capacity also improved: angina-free walking distance significantly increased (from 308 ± 207 to 497 ± 253 meters, P < 0.001), as well as the number of flight of stairs until angina (from 2.9 ± 2.0 to 4.5 ± 2.3, P < 0.001). At 6 months, the number of patients presenting dyspnea decreased from 169 (76.5%) to 87 (39.4%). % of patients with CCS Class I angina increased more than 10-fold during the treatment period (from 2.3% to 27.6%) while % of patients with CCS Class III angina decreased 3-fold (from 30.8% to 10.0%). After 6 months of treatment, mean systolic and diastolic blood pressure decreased by 13.4 ± 13.1 and 6.7 ± 9.4 mm Hg staying within normal ranges, respectively. 3 patients (1.4%) prematurely discontinued the study treatment combination. Conclusions: Conclusion. This analysis supported the antianginal effectiveness of TMZ-bisoprolol in real-life clinical practice.

Clinical Implications and Debates on the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches Trial.

The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) was eagerly awaited study in the field of ischemic heart disease. Following the presentation and publication of ISCHEMIA, multiple opinions and viewpoints get complicated. The ongoing debates have been including the relevance of coronary revascularization, noninvasive diagnostic methods, and invasive ischemic testing in patients with stable ischemic heart disease (SIHD). Prior to ISCHEMIA, observational studies indicated the potential of coronary revascularization for improving clinical outcomes, while the randomized Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial did not support the plausible concept. Although the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) 2 trial implied the superiority of percutaneous coronary intervention over medical therapy alone, the clinical relevance of coronary revascularization to improve outcomes and quality of life has been questioned. As a consequence, the ISCHEMIA trial did not demonstrate clear benefits in reducing clinical events but showed antianginal effects of revascularization. This landmark trial also suggested the difficulties of noninvasive ischemia testing rather than computed tomography angiography. Despite the complex results, the ISCHEMIA trial may simplify the clinical indications of coronary revascularization in patients with SIHD. Future publications from the ISCHEMIA trial and debates on the results will sharpen our thinking and understanding.

Possibilities of carboxytherapy for diseases of the cardiovascular system

The aim of the study was to analyze the mechanisms of action and pharmacodynamics of carboxytherapy in diseases of the cardiovascular system (CVS). Materials and methods. An analysis of domestic and foreign experience in the use of carboxytherapy for diseases of CVS. Results and discussions. The mechanism of action of carboxytherapy is based on the principle of the introduction of carbon dioxide (CO2) in the patient's body, due to which many pathological disorders can be eliminated. Inhalation and non-inhalation introduction of CO2 into the body has been used for medicinal purposes for many decades. The empirical (off label) use of this therapy in course of time has gained a wide clinical evidence base. There is a large amount of clinical evidence in the world of the effective use of carboxytherapy in many fields of medicine, including those with CVS diseases. It is proved that CO2 introduced into the body penetrates freely through cell membranes and has antihypoxic, vasodilating, antioxidant, anti-ischemic, antispasmodic and other positive effects. Therefore, carboxytherapy contributes to a complex of pharmacological effects inherent of traditional antianginal, hypotensive, antispasmodic and other drugs that are widely used in the treatment of CVS diseases. Conclusions. An analysis of domestic and foreign experience in carboxytherapy shows that the effects of CO2 in diseases of the CVS are achieved by improving oxygenation and microcirculation, anti-anginal, anti-inflammatory, antihypertensive, antispasmodic, anti-oxidant, and analgesic effects of this gas. Carboxytherapy is an alternative, promising and safe method of treating diseases of the cardiovascular system.

Nebilet® – the beta-blocker with vasodilating properties: the new opportunities and application prospects

The lecture is devoted to the clinical use of a beta-blocker with vasodilating properties, namely nebivolol (Nebilet). The major pharmacological properties and characteristics of the drug, its cardioselectivity and mechanisms of vasodilating action are considered. The special place of nebivolol in the treatment of essential hypertension, ischemic heart disease and heart failure has been shown. The drug does not have a diabetogenic effect when taken for a long time, it has a positive effect on lipid and carbohydrate metabolism. Nebivolol demonstrates antianginal and anti-ischemic effects in patients with coronary artery disease, and reduces the recurrence rate after coronary artery surgery. The drug has been shown to be well tolerated and highly effective in reducing mortality rates in chronic heart failure patients with over 70 years old, regardless of the left ventricular ejection fraction. Since 2020, the only nebivolol (Nebilet) has a registered indication – coronary artery disease. The vasodilating beta-blockers should be preferred in the treatment of patients with coronary artery disease and type 2 diabetes mellitus.

Statementtype in complex rehabilitation and secondary prevention of cardiovascular disorders in patients with coronary heart disease

The single-center randomized comparative study on revealing the clinical efficacy of the complex method of rehabilitation and secondary prevention of cardiovascular disorders in patients with ischemic heart disease with the inclusion of physical training with the use of stabilometric complex with biofeedback (stabilo-training), general iodine-bromine baths and infrared laser therapy in patients with ischemic heart disease in the remote period after surgical revascularization of myocardium. Observation was made in 60 patients with ischemic heart disease, in remote, not earlier than one year, terms after surgical revascularization of myocardium. Patients were divided into 2 groups by simple randomization method. Group 1, the main group consisted of 30 patients who received a complex rehabilitation method with the inclusion of stabilizing training, general iodine-bromine baths and infrared laser therapy; group 2, the comparison included 30 patients who received a rehabilitation course with the inclusion of general iodine-bromine baths and infrared laser therapy only. Cardiovascular disorders (CVD) were evaluated using electrocardiography (ECG) in standard leads, echocardiography (ECG), daily ECG monitoring with assessment of cardiac rhythm variability, veloergometry (VEM), stabilometry and a 6-point rating scale and psychological testing with the help of HAM and Spielberg tests. The study results were processed using the Statistica 8 for Windows application package. Preliminary calculation of sample power showed a sufficient number of patients in groups of 30 people. Calculation of statistical reliability of the results was performed by the Student-Fisher criterion. The differences between the two mean values were considered reliable at p<0.05. Under the influence of the complex with inclusion of statokinesoterapy in patients with IHD of the main group in comparison with the comparison group, more expressed antianginal and antiarrhythmic effects, increase of tolerance of physical activity, physical efficiency were noted. Positive ECG dynamics, increased cardiac output fraction, improved mood and sleep were noted. Positive dynamics of SSN in 85% of patients of the main group and in 65% of the comparison group was accompanied by increased stability in the vertical posture, decreased walking precariousness, improved coordination and equilibrium, decreased indices of the pressure center deviation (CD) in frontal and sagittal directions. The average rate of displacement of CD and the total area of the statokinesiogram decreased only in the main group of patients, in the comparison group the stated indices of stabilometry remained without dynamics. The total dynamics index of symptom severity decreased by 11±0.03 points in the main group of patients and by 6.7±0.01 points in the comparison group. The revealed positive clinical effects in patients with IHD in the distant period after surgical revascularization of myocardium, a complex method with inclusion of stabilokinesotherapy, allows to recommend this method of sensomotor physical training in complex rehabilitation programs with the purpose of SSN correction, prevention of development of acute coronary syndrome and heart insufficiency.

New opportunities to improve the treatment effectiveness of patients with stable angina

Aim To study the antianginal and heart rate slowing effects in patients with stable angina (SA) who failed to achieve the heart rate (HR) goal and were switched from the beta-blocker (BB) metoprolol tartrate to a combination of metoprolol tartrate and ivabradine.Materials and methods The study included 54 patients with SA not higher than functional class (FC) III (35 (64.8 %) men and 19 (35.2 %) women) aged 59 [48; 77] years. Prior to the study start and at 4 and 8 weeks of follow-up, electrocardiography (ECG) and 24-h ECG monitoring (24h-ECGM) were performed for all patients. The follow-up period duration was 8 weeks. The antianginal and heart rate slowing effects of therapy were clinically evaluated by a decrease in frequency of anginal attacks and patients' requirement for nitrates, a decrease in HR, and the effect on 24h-ECGM indexes characterizing myocardial ischemia. At the first stage, all patients were prescribed metoprolol tartrate (Egilok®, Egis, Hungary) 25 mg twice a day. Patients with resting HR still higher than 70 bpm after 4 weeks of treatment were switched from metoprolol tartrate to a fixed ivabradine/metoprolol combination (Implicor®, Servier, France) 5 / 25 mg twice a day. Thus, based on achieving/ non-achieving the HR goal, two groups of patients were formed. Statistical analysis was performed with a STATISTICA 10,0 software package.Results After 4 weeks of therapy with metoprolol tartrate 25 mg twice a day, 18 (33.3%) patients of group 1 achieved the HR goal of 70 bpm, while 36 (66.7%) patients of group 2 did not achieve the goal. For further correction of HR, patients of group 2 were switched from metoprolol tartrate to ivabradine/metoprolol 5 / 25 mg twice a day. After 4 weeks of the ivabradine/metoprolol treatment, 31 (86.1 %) patients achieved the HR goal with median resting HR of 62 [56; 70] bpm. The number of angina attacks decreased from 6 [3; 8] to 2 [1; 3] per week (р<0.001). 24hECGM showed that the mean diurnal HR decreased from 81 [76; 96] to 66 [56; 76] bpm (р<0.001); mean night HR decreased from 69 [73; 80] to 52 [43; 60] bpm (р=0.012); and the ischemic ST segment depression was absent.Conclusion Only 33.3% of patients with stable angina achieved the HR goal on metoprolol tartrate 25 mg twice a day. Supplementing the beta-blocker metoprolol tartrate at the same dose with ivabradine allowed 86.1% of patients to achieve the HR goal and exerted a pronounced anti-anginal effect.

P427Influence of ranolazine on cardioversion rate in patients with new onset atrial fibrillation and ischemic disease of the heart

Abstract Background Ranolazine is a piperazine derivative, mainly used as antianginal drug in patients with ischemic disease of the heart (IDH). Despite its antianginal effect, it has an antiarrhythmic effect by inhibiting of late sodium and rapid potassium rectifier current. Aim of the study was to assess the additional antiarrhythmic efficacy of ranolazine in patients with new onset atrial fibrillation (AF) and IDH. Material and Methods 168 eligible patients with IDH and short duration of new onset AF were enrolled in this study. Among them, 92 were treated additionally ranolazine to the standart therapy – Group I while 76 only with standart therapy – Group II. The choice of antiarrhythmic drug for cardioversion was either amiodarone or propafenone at the discretion of the doctor. Primary endpoint was recovering of sinus rhythm. All statistical analysis were performed using student t-test. Results Mean age of patients was 66 ± 11.5 years, male 48% in ranolazine group (Group I) and 64.5 ± 12.0 years, male 46% in Group II, and there were no statistically significant differences between two groups. Both groups of patients were characterized by median AF episode duration of 12 (4; 24) hours. Amiadoron was administered in 70 % (n = 65) of patients in Group I and in 77% (n = 59); propafenon in 30% (n = 17) of patients in Group I and 23% (n = 17) in Group II. Cardioversion rate was significantly higher in Group I than Group II (87% vs. 74%, P < 0.05;). There were not observed safety endpoints in Group I whereas 3 safety endpoints (severe bradycardia and arterial hypotension) were observed in Group II (P > 0.05). Conclusion Adding ranolazine to the standard therapy in patients with IDH seems to have a beneficial role in restoring sinus rhythm in recent new onset AF.

Evaluation of the antianginal effectiveness of trimetazidine in a new dosage form for a single dose, depending on the region of the Russian Federation. ODA trial results

Used database research ODA (Evaluation of the effectiveness and therapeutic response to Preductal OD 80 mg in everyday practical use for the treatment of stable angina), which was conducted in 56 cities of the Russian Federation. The analysis was carried out in the Central, North-West, Volga districts and regions united by the territorial principle - Southern + North Caucasian + Crimea + Sevastopol and Ural + Siberian + Far Eastern. By region, there were no differences in the ratio of men and women included in the observation, the number of smoking patients (about 15%), overweight (about 80% of patients), arterial hypertension (exceeding 85%),dyslipidemia (over 90%), and atrial fibrillation (met at each 8-10 included patient). The proportion of patients older than 65 years was greater in the Central, North-West and Ural regions. Unfavorable heredity in coronary artery disease is more common in the Southern, Central and Ural regions. More than 2/3 of the patients had low physical activity, and in the South - their number reached ¾ of all included in the observation. The largest number of patients with diabetes was in the Central and North-West regions (every fourth patient), in the Ural region every fifth. The lowest frequency of statin prescribing was in the Volga region. The smallest number of those receiving RAS inhibitors was in the North-West, Ural and South regions. Beta blockers took more than 80% of patients. Only 35% of patients had a target systolic blood pressure. The smallest proportion of people with target blood pressure values was in the NorthWest and South regions. Adding TMZ OD to therapy or replacing previous therapy with trimetazidine on TMZ OD in all regions resulted in a significant (p <0.001) decrease in the incidence of angina attacks by as early as 1 month of therapy and the antianginal effect increased by the third month of treatment. By the third month of treatment, the average frequency of angina attacks was the lowest in the North-Western and Ural regions (significantly lower than even in the Central region) and remained higher only in the Volga region compared to the Central, North-Western and Ural regions. During follow-up, treatment compliance increased significantly in all regions. The fight against major risk factors remains insufficient and efforts should be made to change the situation in all regions of the Russian Federation. The inclusion of trimetazidine in therapy in the new TMZ OD dosage form allows to obtain a pronounced antianginal effect and increase adherence to therapy. Low adherence can be overcome by careful observation and closer contact between doctors and patients.

Long-term results of isolated transmyocardial laser revascularization in combination with the intramyocardial autologous bone marrow stem cells injection.

To evaluate the long-term results of TMLR using a CO2 laser in combination with intramyocardial injection of ABMSC as an isolated procedure in patients with the end-stage coronary artery disease, the study included 20 patients (90% male), with a mean age of 58.4 ± 8.7 years. To assess the long-term results, patients were examined in a hospital. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Seattle Angina Questionnaire (SAQ) were used. The evolution of laboratory and instrumental indices, as well as medical therapy, was assessed. The end points of the study were death, acute myocardial infarction (AMI), repeated myocardial revascularization, recurrent hospitalizations due to coronary artery disease, and stroke. The changes in angina functional class were also evaluated. The median of follow-up period was 54 (36; 83) months, that is, 4.5 years. The analysis of the evolution of echocardiographic data showed the absence of statistically significant changes in the following parameters: left ventricular end-diastolic diameter (EDD) (p = 0.967), end-systolic diameter (ESD) (p = 0.204), end-diastolic volume (EDV) (p = 0.852), end-systolic volume (ESV) (p = 0.125), and left ventricular ejection fraction (LVEF) (p = 0.120). The patients continued to regularly take the main groups of medications. Nitrate consumption was significantly reduced (p < 0.001). Significant positive dynamics were observed in the changes in angina functional class. At the baseline, all patients had angina III FC, in the long term, 3 patients had II FC, 11 patients had I FC, and 6 patients had no angina. Clinical outcomes (mortality, recurrent myocardial infarction, stroke) were absent during the follow-up period. There were two cases of repeated myocardial revascularization. Regression analysis revealed that SYNTAX score was associated with the clinical outcome "repeated revascularization." TMLR in combination with intramyocardial injection of ABMSC is a safe method to achieve a statistically significant antianginal effect and reduce the need for "nitrates," which in turn improves the quality of life and reduces the frequency of hospitalizations due to coronary artery disease. These results can be achieved with strict adherence to the certain indications for the intervention.

Efficacy, Safety and Long-term Outcomes of Nicorandil Use in Patients with Stable Ischemic Heart Disease According to the Results of Randomized and Observational Studies

Working Group of the NIKEA Study. Yekaterinburg: Akulina E.N., Reznik I.I.; Izhevsk: Grebnev S.A., Yezhov A., Shinkareva S.E.; Krasnodar: Kudryashov E.A., Skibitsky A.V., Skibitsky V.V., Fendrikova A.V.; Krasnoyarsk: Altayev V.D., Matyushin G.V., Nemik D.B., Pitaev R.R., Samokhvalov E.V., Stolbikov Yu.Yu.; Moscow: Balashov I.S., Voronina V.P., Gaisenok O.V., Dmitrieva N.A., Zagrebelny A.V., Zakharova A.V., Zelenova T.I., Kolganova E.V., Leonov A.S., Lerman O.V., Maximova M.A., Sladkova T.A., Shestakova G.N.; Novosibirsk: Kuimov A.D., Shurkevich A.A.; Omsk: Goodilin V.A., Loginova E.N., Nechaeva G.I.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M., Mitroshina T.N.; Orenburg: Kondratenko V.Yu., Libis R.A.; Rostov-on-Don: Dubishcheva N.F., Kalacheva N.M., Kolomatskaya O.E., Romadina G., Skarzhinskaya N.S., Chesnikova A.I., Chugunova I.B.; Ryazan: Dobrynina N.V., Nikolaev A.S., Trofimova Ya.M., Yakushin S.S.; Tula: Berberfish L.D., Gomova T.A., Gorina G.I., Dabizha V.G., Zubareva L.A., Nadezhkina K.N., Nikitina V.F., Renko I.E., Soin I.A., Yunusova K.N.Background. Nicorandil is an antianginal drug for which, the ability to positively influence the prognosis of patients (pts) with stable ischemic heart disease (IHD) was confirmed in a randomized controlled trial (RCT) of IONA (the Impact Of Nicorandil in Angina). To study whether the results of RCTs are reproduced in real clinical practice seems to be an actual scientific and practical task.Aim. To compare the data on the effectiveness and safety of nicorandil in pts with stable IHD obtained in the NIKEA observational study (OS) and in the IONA randomized study.Material and methods. 590 pts with IHD and stable angina pectoris were included in the OS NIKEA. All pts were recommended to take nicorandil in addition to the standard antiischemic therapy. 21 months after being included in the study, 524 pts received a phone call. During the telephone contact with pts or their relatives, the life status of pts was determined. According to these results of the survey data were obtained, that 15 people died and 509 pts were alive. The events included in the primary combined endpoint (PCEP) were also determined: death from all causes, new cases of acute myocardial infarction and acute cerebrovascular accident, unscheduled operations of myocardial revascularization, hospitalization for decompensation of chronic heart failure, atrial fibrillation, unstable angina, information on taking nicorandil and other drug therapy, adverse events of drug treatment have been reported. A comparative analysis of the results of the OS NIKEA and RCT IONA was carried out. The results of the IONA study were taken according to the publication in the Lancet 2002. A comparative analysis of the results of the effectiveness of nicorandil in real practice (according to the OS results) was performed with the data obtained in the RCT: the nicorandil/placebo groups in the RCT were compared with the adherent/non-adherent nicorandil groups in the OS.Results. The follow-up duration in both studies was similar and averaged 1.6±0.5 years at RCT IONA and 1.8±0.4 years at NIKEA study. The average age of pts was 67,0±8,0 years in RCT and 65.1±9.6 years in OS. In pts of OS more pronounced comorbidity was noted (cardiovascular diseases, diabetes mellitus). Drugs that favorably affect the prognosis in pts with IHD were more often prescribed to NIKEA study pts (p&lt;0.05). In both RCTs and OS, the antianginal effectiveness of nicorandil was confirmed. According to the OS results, a reduction in the number of angina attacks and a decrease in the need for short-acting nitrates were demonstrated. The frequency of PCEP components was higher in RCT.Conclusion. Long-term outcomes according to the NIKEA observational program for various components of the PCEP turned out to be similar to the results of RCT IONA. It is demonstrated the efficacy of nicorandil in real clinical practice.

If Channel Inhibition - Ivabradine for the Treatment of Heart Failure

The novel first-in-class If channel antagonist, Ivabradine, is effective in improving clinical outcomes and functional capacity, in patients with HF, as well as demonstrating useful anti-anginal and protective anti-ischaemic effects. It can help improve heart rate control and can be usefully co-administered with beta blockers on HFrEF patients with residually elevated resting sinus rhythm heart rate. We review the clinical trial evidence for the benefits of Ivabradine in the treatment of heart failure.

Possibilities of cardioselective beta - blocker bisoprolol therapy in patients having coronary artery disease and bronchial asthma

to compare the antianginal and pulse slowing effects, the impact on the ectopic myocardial activity as well as the safety of the treatment with beta - adrenoblocker bisoprolol, calcium antagonist verapamil and the combination of bisoprolol with amlodipine in patients with stable angina (SA) and bronchial asthma (BA). The study included 90 patients with SA II-III functional class (FC) having concomitant persistent asthma of moderate severity, controlled, without exacerbation. The patients were divided into three groups with 30 individuals in each one depending on the main antianginal drug prescribed. Group 1 patients received a cardio - selective beta - adrenergic blocker bisoprolol (Concor) at the dose of 5 mg/day, patients of group 2 were treated by a calcium antagonist verapamil at the dose of 240 mg/day, patients of group 3 received combined therapy with bisoprolol at the dose of 5 mg/day and amlodipine at the dose of 5 mg/day given as a fixed combination (Concor AM 5/5). All the patients were investigated by the methods of daily ECG monitoring and respiratory function study (RFS) in addition to physical examination at baseline and after 4 weeks of treatment. After 4 weeks of treatment, patients of group 1 and group 3 did not complain of angina attacks and did not use nitroglycerin unlike patients of group 2. The achieved heart rate (HR) in group 1 patients was 68.6±8.5 beats/min, in group 2 - 74.3±5.6 beats/min, in group 3 - 67.3±4.8 beats/min. A significant decrease in the number of supraventricular and ventricular extrasystoles occurred in patients of group 1 and group 3 only. Thus, the pulse slowing, antianginal, antiischemic and antiarrhythmic effect of the calcium antagonist verapamil, even at the dose of 240 mg/day, is not always sufficient for the patients with SA II-III FC and concomitant BA, unlike therapy with the inclusion of beta - blocker bisoprolol. During the study there was no registered deterioration in the indices of bronchial patency according to the RFS data in the patients of all three groups. In patients with coronary artery disease and concomitant asthma, all three types of pulse slowing therapy do not have any negative effects on bronchial patency. Therapy with the inclusion of beta - blockers (bisoprolol or its combination with amlodipine), in contrast to verapamil, reliably reduces heart rate and the number of supraventricular and ventricular extrasystoles in addition to a good antianginal effect.

Evaluation of the efficiency of combined pharmacotherapy with the use of trimetazidine with prolonged release in patients with stable angina in outpatient practice

To evaluate the effectiveness of complex pharmacotherapy with the inclusion in the treatment regimen of trimetazidine with a prolonged release in patients with stable angina. The pilot study included 22 patients aged 45-75 years with combined cardiovascular pathology. In addition to the received therapy, all patients were prescribed the original trimetazidine with a prolonged release at a dose of 80 mg/day (Preductal® OD, Servier, Russia). The observation period was 2 months. The survey included the double implementation of the following methods: the number of strokes per week, the frequency of use of short - acting nitrates per week, blood pressure, heart rate, echocardiography, daily ECG monitoring, assessment of the quality of life (questionnaire SF-36, questionnaire of patients with stable angina SAQ). When assessing the effect of ongoing pharmacotherapy on clinical and echoCG indicators in patients of the study group, significant positive dynamics was registered in the form of reducing the number of angina attacks and the number of short - acting nitrates used per week, a slight positive dynamics of EF on echoCG, episodes of pain and painless ischemia were eliminated according to the results of Holter monitoring), a significant positive dynamics of quality of life indicators was noted. Combined pharmacotherapy of patients with stable exertional angina with the inclusion of the trimetazidine with a prolonged release at a dose of 80 mg/day (Predductal® OD, Servier, Russia) has a significant positive pharmacodynamic effect in the form of an increase in the antianginal effect, improvement of Holter monitoring indicators and quality of patients life.