Effect of Trimetazidine on Exercise Performance in Patients With Coronary Artery Ectasia

Abstract

SUMMARYCoronary artery ectasia (CAE) is a rare form of coronary artery disease. It has previously been shown that nitrate derivatives induce exertional angina in patients with CAE. Furthermore, there is limited data about the effects of other anti-ischemic agents in CAE. The aim of this study was to investigate the effect of trimetazidine on exercise performance in patients with CAE.The study population consisted of 56 patients with isolated CAE (32 males, mean age: 58 ± 9 years). The presence of myocardial ischemia was evaluated by treadmill exercise test. The exercise test was positive in 49 patients at baseline and in 27 patients during trimetazidine therapy (P < 0.01). The exercise test induced angina in all of the patients who have had a positive test result. Significant ST depressions were observed in 42 and 23 patients before and after the treatment, respectively (P < 0.01). The extent of ST depression at peak exercise was significantly lower on trimetazidine (0.9 ± 0.5 vs 1.5 ± 0.6 mm, P < 0.01). With trimetazidine, the exercise duration increased from 7.8 ± 2.1 to 8.7 ± 2.4 min (P = 0.04 ) and cardiac work-load also increased from 8.9 ± 2.3 to 10.4 ± 2.1 mets (P < 0.01).The results suggest that trimetazidine can relieve exercise-induced angina and improve exercise performance in patients with CAE. (Jpn Heart J 2003; 44: 463-470)

Hypereosinophilic syndrome associated with multiple coronary aneurysms

“…Firstly, whilst in-situ thrombo-embolism within regions of coronary ectasia may predispose to the development of acute coronary syndrome, it is unclear from current literature as to whether anticoagulant or anti-platelet therapy (alone or in combination) is superior in preventing recurrent intracoronary thrombo-embolism. Slow coronary flow in patients with CAE has been described, as has the use of trimetazidine or dipyridamole to augment coronary flow, however results have been generally disappointing [5].…”

Coronary artery aneurysm: A review

“…Complications such as thrombus formation, distal embolization and shunt formation and rupture can occur, 1,4,22,23 but the absolute risk is not known. 4 Myocardial infarction may also occur in the absence of significant coronary artery stenosis and is usually attributed to distal microembolization or thrombotic occlusion of an ectatic segment.…”

“…Some statins could be beneficial by inhibiting MMP-3 activity and corticosteroids and IL-4, and by suppressing MMP expression. 18 Trimethazine can also improve coronary flow in CAE by increasing plasma adenosine levels; 22 dipyridamole may be used as well. 33 However, administration of nitroglycerin and nitrate derivates may induce angina pectoris in patients with CAE and should be avoided.…”

“…33 However, administration of nitroglycerin and nitrate derivates may induce angina pectoris in patients with CAE and should be avoided. 22 Especially with accompanying stenosis, the use of grafted stents, for example, Jostent coronary stent graft, is advocated. 34 The Jostent ® polytertafluoroethylene (PTFE)-covered, balloon-expandable stent (Abbott Vascular Instruments Deutschland GmbH, Rangendingen, Germany) has been shown to be an effective device for the percutaneous management and exclusion of coronary aneurysms.…”

Two Different Successful Angioplasty Methods in Patients with Stenotic Coronary Artery Ectasia

“…CAE can be asymptomatic; however, sometimes patients present with exertional chest pain, acute coronary syndrome, arrhythmia, and sudden death. Complications such as thrombus, distal embolization, and shunt formation can occur 3. Currently, there is no evidence-based guideline for stenotic ectatic coronary arteries because of the various sizes and types of ectatic coronary arteries.…”