Evaluation of the antiischemic effect of a prolonged form of trimetazidine in patients with stable angina pectoris using speckle-tracking technique

Studies of global and segmental myocardial contractility using the speckle-tracking technique in patients suffering from stable angina pectoris compared to healthy individuals are presented. It was revealed that, in patients suffering from stable angina pectoris, the values of longitudinal deformation in the anterolateral and apical segments of the left ventricle, as well as global longitudinal deformation, decrease. Differences in longitudinal myocardial deformation in other segments were not observed in the subjects. Possible causes of a decrease in the longitudinal deformation of the myocardium, both in general and in individual segments of the left ventricle, are examined. The data on longitudinal segmental deformity of the left ventricle on the background of anti-ischemic therapy are presented. A direct correlation between the values of the global longitudinal deformation and the distance traveled by patients before the development of an angina attack was revealed.In addition, a direct correlation was found between the longitudinal deformation of the myocardium in the anterior septal region of the left ventricle and exercise tolerance. Adding a prolonged form of trimetazidine to complex anti-ischemic therapy leads to a significant increase in segmental and global deformity of the left ventricle, which is accompanied by a decrease in the daily need for nitroglycerin and an increase in exercise tolerance. The lack of dynamics of the longitudinal strain in the basal parts of the left ventricle during treatment may be due to the development of cardiosclerosis.

Stabil coronariabetegség kezelésére alkalmazott trimetazidin prolong hatásosságának vizsgálata. Multicentrikus, prospektív, obszervációs, nyílt klinikai vizsgálat, ONECAPS-vizsgálat

Introduction: The effectiveness of the manegement of stable coronary artery disease among outpatients is not well known. Aim: The aim of the study was to evaluate the effect of daily once trimetazidine prolong 80 mg on the angina number and severity (Canadian Cardiovascular Society class). Method: This multicenter, prospective, observational, 3-month clinical study included 2160 patients, but only 1701 patients completed the study. The patients’ mean age was 68 years (17% under 60 years). The start of angina was 7.8 ± 6.7 years. Hypertension (93.4%) and hypercholesterolemia (81%) were very common. Results: The patients were well treated with beta-blocking agents (88%), calcium antagonists (49%), angiotensin-converting enzym inhibitors (90%) and statin (77%) but only 5% received ivabradine and 50.5% was treated with trimetazidine MR. The patients attended 3 visits (inclusion, 1 month, 3 month). During the 3-month period, the weekly angina number of all patients treated with trimetazidine prolong 80 mg decreased from 2.55 to 0.41 (p<0.0001). A favorable effect was observed in CCS grading: CCS I. from 40.37% to 66.81%, CCS II. from 49.89% to 30.59%, CCS III. from 9.17% to 2% and CCS IV. from 0.56% to 0%. The mean office measured blood pressure decreased from 137/83 mmHg to 130/80 mmHg and the heart rate from 74 bpm to 71 bpm. Conclusions: In the real-life, in the stable coronary artery disease the angina remains despite the medical treatment. Once a day administered trimetazidine prolong 80 mg significantly reduced the weekly number of angina and the severity, too. These beneficial effects mediated not only by antiischemic effect but also by increased medication adherence. Orv Hetil. 2018; 159(38): 1549–1555.

Antiischemic and antiarrhytmic effects of angiotensin-converting enzyme inhibitor zofenopril in the rat model of acute myocardial ischemia

Angiotensin-converting enzyme (ACE) inhibitors are widely used in heart failure therapy, but little is known about their antiischemic effccts. The primary aim of this study was to investigate antiischemic effectiveness of SH-containing ACE inhibitor zofenopril in rats in comparison to captopril. The results provide an evidence that zofenopril, in contrast to captopril, reduces infarct size when administered intravenously at a dose of 2,5 mg/kg 30 minutes before ischemia. Antiischemic effect of zofenopril may be due to its high affinity to myocardial tissue. Unlike captopril, zofenopril exerted significant antiarrhythmic effect against ischemic ventricular tachyarrhytmias. Antiischemic effect of zofenopril was evident at a relatively high dose only and, therefore, was associated with considerable hypotensive effect.

Neuroprotective Effects of a Novel Nitrone, NXY-059, after Transient Focal Cerebral Ischemia in the Rat

Recent results have demonstrated that the spin trapping agent α-phenyl- N- tert-butyl nitrone (PBN) reduces infarct volume in rats subjected to 2 hours of middle cerebral artery occlusion, even when given 1 to 3 hours after the start of recirculation. In the current study, the authors assessed the effect of NXY-059, a novel nitrone that is more soluble than PBN. Loading doses were given of 0.30, 3.0, or 30 mg · kg−1 followed by 0.30, 3.0, or 30 mg · kg−1 · h−1 for 24 or 48 hours. Dose–response studies showed that when treatment was begun 1 hour after recirculation, 0.30 mg · kg−1 had a small and 30 mg · kg-i a marked effect on infarct volume. At equimolar doses (3.0 mg · kg−1 for NXY-059 and 1.4 mg · kg−1 for PBN), NXY-059 was more efficacious than PBN. Similar results were obtained when a recovery period of 7 days was allowed. The window of therapeutic opportunity for NXY-059 was 3 to 6 hours after the start of recirculation. Studies of the transfer constant of [14C]NXY-059 showed that, in contrast to PBN, this more soluble nitrone penetrates the blood-brain barrier less extensively. This fact, and the pronounced antiischemic effect of NXY-059, suggest that the delayed events leading to infarction may be influenced by reactions occurring at the blood–endothelial interface.