benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina
DESCRIPTION
Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina. Review of the main studies. Is coronary obstruction the only player in ischemic heart disease?. Sambuceti G . Eur J Nucl Med Mol Imaging . 2005;32:385-388. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/1.jpg)
Benefits of adding a energetic agent to -blockers to achieve optimal reduction
of angina.
Review of the main studies
![Page 2: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/2.jpg)
Is coronary obstruction the only player in ischemic heart disease?
Sambuceti G. Eur J Nucl Med Mol Imaging. 2005;32:385-388.
![Page 3: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/3.jpg)
Is coronary obstruction the only player in ischemic heart disease?
Cheng VY, et al. Circulation. 2011;124:2423-2432.
![Page 4: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/4.jpg)
Marzilli M, et al. J Am Coll Cardiol. 2012;60:951-956.
Myocardial ischemia is multifactorial
![Page 5: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/5.jpg)
Marzilli M, et al. J Am Coll Cardiol 2012;60:951–6.
Ischemia is an energy deficiency
![Page 6: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/6.jpg)
Increased energy in the ischemic heart
P=0.04
1,00
1,50
2,00P
cr/A
TP
rat
io
placebo TMZ
+33%
Fragasso G, et al. Eur Heart J. 2006;27:942-948.
![Page 7: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/7.jpg)
Cellular energy balance
Act on both sides of the cellular energy balance
To protect the cells from ischemia, the energy supply needs to remain greater than the energy demand.
![Page 8: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/8.jpg)
Time to 1-mm ST depression
Trimetazidine
Placebo
Time to onset of angina
Angina attacks/week (n) Nitrate use / week (n)
n=426Stable angina patientsAll on metoprolol(50 mg/day)
Szwed H, et al. TRIMPOL II Eur Heart J. 2001;22:2367-2374.
P<0.01
NS
W0 W12
450
400
350
300
Tim
e (
s)
5
2
1
0
4
3
An
gin
a a
ttacks
W0 W12
NS P<0.01
W0 W12
Tim
e (
s)
NS
P<0.01500
400
350
300
450
4
2
1
0
3
Mean
n
itra
te u
se /
week (
n)
W0 W12
NS P<0.01
Proven antianginal efficacy with -blockers
![Page 9: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/9.jpg)
Proven antianginal efficacy with -blockers
Michaelides AP, et al. Clin Drug Invest. 1997;13:8-14.
n=53Stable angina patients uncontrolled withPropranolol 40 mg/day
![Page 10: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/10.jpg)
Proven antianginal efficacy with -blockers
Nesukay E, et al. ESC 2013. Abstract 86728.
![Page 11: Benefits of adding a energetic agent to - blockers to achieve optimal reduction of angina](https://reader036.vdocuments.site/reader036/viewer/2022070418/5681598e550346895dc6d8bc/html5/thumbnails/11.jpg)
Conclusions
Chronic ischemic heart disease (IHD) is still a significant clinical burden
IHD results from a number of mechanisms
To ensure optimal management of IHD on top of -blockers, it is essential to address the energetic origin of ischemia
Trimetazidine MR is an effective drug to use in combination with β-blockers to relieve angina effectively.