No abstract

Trimetazidine (TMZ) has been shown to have anti-ischaemic properties improving exercise tolerance without haemodynamic effects. A 6-month double-blind placebo-controlled study was carried out in 20 patients, mean age 59 +/- 6 years, to examine the benefit of adding 60 mg of TMZ vs placebo to the classical therapy, excluding those previously treated with calcium-antagonists, conversion enzyme inhibitors, vasodilators and antiplatelet agents. All patients had severe ischaemic cardiomyopathy, confirmed by coronary angiography; six were in NYHA class IV; 14 in NYHA class III; four had mild recurrent angina pectoris. assessment included clinical and biological evaluation, electrocardiography (ECG), 24-h ECG monitoring, cardiac volume evaluation with chest X-ray, left ventricular fractional shortening by echocardiography, left ventricular ejection fraction by radionuclide angiography. Baseline characteristics were similar in placebo (11 patients) and TMZ (nine patients) groups. Eighteen patients (nine in each group) were followed up for 6 months. In eight patients of the placebo group, treatment had to be modified (addition of calcium antagonists: four patients, conversion enzyme inhibitors: two patients; digitalics: one patient; diuretics: one patient). In the TMZ group, digitalic therapy was withdrawn in one patient and added in one patient (P less than 0.01). At 6 months, all TMZ group patients were free from angina; dyspnoea was improved in all TMZ patients and in only one placebo patient (P less than 0.001). Ejection fraction, increased by 9.3% in the TMZ group and decreased by 15.6% in the placebo group (P less than 0.018), CV decreased by 7% with TMZ, increased by 4% with placebo. (P = 0.034).(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract

Spontaneous coronary artery dissection is a rare disease with a higher prevalence in women, especially in the post-partum state. In one case, we attempted to relate this pathology to a disorder in collagen metabolism. A 32-year-old woman presented two episodes of myocardial infarction, 2 and 4 months after delivery which were shown to be due to two consecutive coronary artery dissections on coronary angiogram. Collagen metabolism was investigated in skin fibroblast cultures derived from the patient, and in control fibroblast cultures. After protein labelling in culture, total protein and collagen synthesis were determined. Quantification of procollagen synthesized in cell cultures and their rate of conversion into collagen were determined both in the culture media and a cell layer extract by DEAE cellulose chromatography. The results showed a reduced total collagen synthesis in the cultures of the patient in comparison with control cultures. The ratio between type I and III procollagen was not altered. The rate of conversion of procollagen into collagen was higher in the pathological cultures than in control cultures. Impaired collagen synthesis due perhaps to a change in hormonal equilibrium in the post-partum state might therefore have been responsible for coronary artery dissection.