Effects of Ivabradine and Ranolazine in Patients With Microvascular Angina Pectoris

Villano, Angelo; Franco, Antonino Di; Nerla, Roberto; Sestito, Alfonso; Tarzia, Pierpaolo; Lamendola, Priscilla; Monaco, Antonio Di; Sarullo, Filippo M.; Lanza, Gaetano Antonio; Crea, Filippo

doi:10.1016/j.amjcard.2013.02.045

Cited by 155 publications

(131 citation statements)

References 29 publications

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“…However, despite previous reports showing a Risk favourable effect for ranolazine in small patient groups with CMD [21,22] a recent randomized, double-blind, placebocontrolled, crossover trial showed no treatment differences in the outcomes. Among the 128 subjects (96 % women) ranolazine did not improve angina measured by the Seattle Angina Questionnaire and myocardial perfusion reserve index measured by cardiac magnetic resonance imaging compared to placebo [23].…”

Section: Recommendations For Treatmentmentioning

confidence: 58%

See 1 more Smart Citation

Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction

Ong

Athanasiadis

Sechtem

2016

Cardiovasc Drugs Ther

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Treatment of angina pectoris associated with coronary microvascular dysfunction is challenging as the underlying mechanisms are often diverse and overlapping. Patients with type 1 coronary microvascular dysfunction (i.e. absence of epicardial coronary artery disease and myocardial disease) should receive strict control of their cardiovascular risk factors and thus receive statins and ACE-inhibitors in most cases. Antianginal medication consists of ß-blockers and/or calcium channel blockers. Second line drugs are ranolazine and nicorandil with limited evidence. Despite individually titrated combinations of these drugs up to 30 % of patients have refractory angina. Rho-kinase inhibitors and endothelin-receptor antagonists represent potential drugs that may prove useful in these patients in the future.

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Section: Recommendations For Treatmentmentioning

confidence: 58%

“…This leads to prolongation of diastole and thus improvement of coronary perfusion. The drug has been studied in a small group of patients with CMD [21] showing an improvement in clinical symptoms but not in coronary flow reserve. It is thus of limited use in patients with CMD.…”

Section: Recommendations For Treatmentmentioning

confidence: 99%

Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction

Ong

Athanasiadis

Sechtem

2016

Cardiovasc Drugs Ther

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“…106 A similar-sized study showed some improvement in symptoms but no effect on coronary microvascular function. 107 A recent large randomized trial of a 2-week course of ranolazine vs. placebo found no difference in symptoms or myocardial perfusion reserve. 108 Ivabradine reduces the heart rate through its effect on the If current of the sinoatrial node.…”

Section: Invasive Testingmentioning

confidence: 98%

“…109 Another study showed improvement in symptoms, but no effect on coronary microvascular function. 107 Ivabradine may have a therapeutic role in CMD patients.…”

Section: Invasive Testingmentioning

confidence: 99%

Coronary Microvascular Dysfunction　― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

Chen

Wei

AlBadri

et al. 2017

Circ J

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Angina has traditionally been thought to be caused by obstructive coronary artery disease (CAD). However, a substantial number of patients with angina are found to not have obstructive CAD when undergoing coronary angiography. A significant proportion of these patients have coronary microvascular dysfunction (CMD), characterized by heightened sensitivity to vasoconstrictor stimuli and limited microvascular vasodilator capacity. With the advent of non-invasive and invasive techniques, the coronary microvasculature has been more extensively studied in the past 2 decades. CMD has been identified as a cause of cardiac ischemia, in addition to traditional atherosclerotic disease and vasospastic disease. CMD can occur alone or in the presence obstructive CAD. CMD shares many similar risk factors with macrovascular CAD. Diagnosis is achieved through detection of an attenuated response of coronary blood flow in response to vasodilatory agents. Imaging modalities such as cardiovascular magnetic resonance, positron emission tomography, and transthoracic Doppler echocardiography have become more widely used, but have not yet completely replaced the traditional intracoronary vasoreactivity testing. Treatment of CMD starts with lifestyle modification and risk factor control. The use of traditional antianginal, antiatherosclerotic medications and some novel agents may be beneficial; however, clinical trials are needed to assess the efficacy of the pharmacologic and non-pharmacologic therapeutic modalities. In addition, studies with longer-term follow-up are needed to determine the prognostic benefits of these agents. We review the epidemiology, prognosis, pathogenesis, diagnosis, risk factors and current therapies for CMD.

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“…Classical antiischemic medications, particularly beta-blockers, are the mainstream of the therapy [31]. Villano et al [32] have demonstrated a beneficial effect of ivabradine on angina symptoms and quality of life in 16 MVA patients, independently from many major direct effects on systemic vascular and coronary microvascular function.…”

Section: Microvascular Angina Pectorismentioning

confidence: 99%