Рациональная фармакотерапия в кардиологии (Jul 2020)

Efficacy of Trimetazidine and Sulodexide in Patients with Microvascular Angina

  • S. A. Boldueva,
  • I. A. Leonova,
  • O. V. Zakharova

DOI
https://doi.org/10.20996/1819-6446-2020-06-12
Journal volume & issue
Vol. 16, no. 3
pp. 363 – 369

Abstract

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Background. Despite the progress in the diagnostics of microvascular angina (МА) there is no effective pathogenetic therapy.Aim. To study the effect of trimetazidine and sulodexide as a part of drug therapy on clinical manifestations, exercise tolerance, quality of life, myocardial perfusion and endothelial function in patients with MA.Material and methods. Patients with MA (n=90) were included into the study and randomized into 3 groups. Patients of the first group (control; n=30) received standard antianginal therapy. The second group (treatment group; n=30) received standard therapy and sulodexide (1 ampoule of 600 IU intramuscularly for 10 days, then 1 capsule of 250 IU, 2 times a day). Patients of the third group (treatment group; n=30) received standard therapy and trimetazidine with modified release 35 mg 2 times a day. Evaluation of angina symptoms and quality of life by the Seattle Questionnaire, stress (treadmill) test, positron emission tomography (baseline, adenosine test, cold-pressor test), peripheral arterial tonometry were performed at baseline and 3 months after starting treatment.Results. After 3 months of treatment a significant improvement in symptoms, quality of life and results of stress-test were observed only among patients of treatment groups, most pronounced in the 3rd group. Patients of this group showed an increase in myocardial blood flow >25% according to positron emission tomography (from 86.2±29.7 to 129.5±41.0 ml/100g/min, p<0.05 for anterior interventricular artery; from 93.3±30.5 to 131.7±32.7 ml/100g/min, p<0.05 for circumflex artery; from 91.3±30.4 to 135.9±41.1 ml/100g/min, p<0.05 for right coronary artery) and a significant increase in coronary reserve, as well as an improvement in endothelial function: an increase in coronary reserve of endothelium-dependent vasodilation, an increase in the reactive hyperemia index according to peripheral arterial tonometry (from 1.44±0.14 to 1.73±0.18, p<0.001).Conclusion. Improvement of the clinical picture, quality of life, myocardial perfusion, and endothelial function was observed among microvascular angina patients who were treated with standard antianginal therapy and trimetazidine.

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