Abstract | OBJECTIVE: About one-third of patients undergoing percutaneous coronary interventions (PCIs) for flow-limiting coronary stenosis continue to develop signs of myocardial ischemia (MI) during exercise stress test [EST], despite successful coronary revascularization. Coronary microvascular dysfunction is a likely major cause of the persistence of EST-induced MI in these patients. PATIENTS AND METHODS: We studied 15 patients (14 men, age 67±5 years) fulfilling the following strict inclusion criteria: (1) recent PCI (<6 months), with drug-eluting stent, of coronary artery stenoses for stable angina, with evidence of full success (no residual stenosis >20% in any vessel); (2) persistence of ST-segment depression induction during EST. After a basal investigation, patients received either ranolazine (375 mg bid) or isosorbide-5-mononitrate (ISMN, 20 mg bid) for 3 weeks in a single-blind, randomized crossover study. Clinical assessment, symptom-limited EST, echocardiographic color-Doppler, with tissue-Doppler examination, and coronary microvascular dilator response to adenosine (CFR- ADO) and cold pressor test (CFR- CPT), assessed by transthoracic echo-Doppler, were obtained at baseline and the end of the 3-week therapy with each drug. RESULTS: Compared to both baseline and ISMN, ranolazine showed a longer time to 1 mm ST-segment depression (404±116 s vs. 317±98 and 322±70 s, respectively; p<0.01). No differences were observed in coronary microvascular function and diastolic left ventricular function between the 2 drugs and compared to baseline. CONCLUSIONS: Our data show that ranolazine, but not ISMN, improved time to ischemia during EST. This effect, however, was independent of any effects on coronary microvascular and diastolic function.
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Authors | M Golino, F R Spera, L Manfredonia, A De Vita, A Di Franco, P Lamendola, A Villano, V Melita, E Mencarelli, G A Lanza, F Crea |
Journal | European review for medical and pharmacological sciences
(Eur Rev Med Pharmacol Sci)
Vol. 22
Issue 19
Pg. 6545-6550
(10 2018)
ISSN: 2284-0729 [Electronic] Italy |
PMID | 30338825
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Vasodilator Agents
- Ranolazine
- Isosorbide Dinitrate
- isosorbide-5-mononitrate
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Topics |
- Aged
- Coronary Circulation
(drug effects)
- Coronary Stenosis
(diagnostic imaging, physiopathology, therapy)
- Coronary Vessels
(diagnostic imaging, drug effects, physiopathology)
- Cross-Over Studies
- Female
- Humans
- Isosorbide Dinitrate
(adverse effects, analogs & derivatives, therapeutic use)
- Male
- Microcirculation
(drug effects)
- Microvessels
(diagnostic imaging, drug effects, physiopathology)
- Middle Aged
- Percutaneous Coronary Intervention
(adverse effects)
- Ranolazine
(adverse effects, therapeutic use)
- Rome
- Single-Blind Method
- Time Factors
- Treatment Outcome
- Vasodilator Agents
(adverse effects, therapeutic use)
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