COMPARATIVE ASSESSMENT OF LARGE ARTERY ELASTICITY IN PATIENTS WITH STABLE ANGINA RECEIVING METABOLIC THERAPY

Aim. To assess the effects of metabolic therapy, administered together with standard antianginal treatment, on large artery elasticity and endotheliumdependent vasodilation in patients with stable angina and subsequent heart failure. Material and methods. The study included 74 patients with coronary heart disease (CHD), stable angina of II–III Functional Class (FC), and FC II–III chronic heart failure (CHF). In the main group, standard antianginal treatment was combined with metabolic therapy (trimetazidine, trimethylhydrazinium propionate, and isosorbide dinitrate) for 4 months; the control group received standard treatment only. Results. The four-month metabolic therapy failed to substantially improve the pulse wave velocity (PWV) in elastic arteries. In muscular arteries, PWV significantly decreased during the treatment with isosorbide dinitrate, which negatively affected endothelium-dependent vasodilation of radial arteries. However, trimetazidine treatment was associated with a significant improvement in endothelial function, as well as with a significant reduction in anginal FC and a substantial improvement in exercise capacity. Trimethylhydrazinium propionate therapy was linked to non-significant positive dynamics of these parameters. Conclusion. In stable angina patients, the combination of trimetazidine and standard antianginal therapy was associated with a significant improvement in endotheliumdependentvasodilation of muscular arteries. Consideringits positiveimpact on endothelial function and the absence of direct effects on arterial tonus in stable angina, trimetazidine therapy was more effective than isosorbide dinitrate treatment.

Pulse wave velocity, endothelium-dependent arterial reactivity, trimetazidine, endothelial function

1. Diagnostics and treatment of a stable angina. In National clinical guidelines. Moscow. 2009. pp. 332–382. Russian (Диагностика и лечение стабильной стенокардии. В кн. Национальные клинические рекомендации. М. 2009. c. 332–382).

2. Aronov D.M. The Cascade of therapeutic effects statins. Cardiology, 2004; 10:85–94. Russian (Аронов Д.М. Каскад терапевтических эффектов статинов. Кардиология, 2004; 10:85–94).

3. Kochkina M.S, Zatejshchikov D. A., Sidorenko B. F. Measurement of stiffness of arteries and its clinical value. Cardiology, 2005; 1:63–71. Russian (Кочкина М.С., Затейщиков Д.А., Сидоренко Б.Ф. Измерение жесткости артерий и ее клиническое значение. Кардиология, 2005;1:63–71).

4. Asmar R. Arterial Stiffness and Pulse Wave Velocity Clinical Applications. France, Paris 1999; 167 p.

5. Lopatin Y. M., Ilyukhin O. V., Ilyukhin M. V. et al. Elasticity of arteries and pulse wave velocity at patients with a chronic heart failure of a various etiology. J. Heart Failure, 2004; 4:130–131. Russian (Лопатин Ю. М., Илюхин О.В., Илюхина М.В. и др. Эластичность артерий и скорость пульсовой волны у больных с хронической сердечной недостаточностью различной этиологии. Журнал сердечная недостаточность, 2004;4:130–131).

6. Asmar R., Benetos A., Topouchian J. et all. Assessment of Arterial Distensibility by Automatic Pulse Wave Velocity Measurement (Validation and Clinical Application Studies). Hypertension. 1995;26:485–490.

7. Ilyukhin O.V, Ilyukhina M.V, Kalganova E. L., et al. Pulse wave velocity in an estimation of endothelial dysfunction at patients with a chronic heart failure of an ischemic etiology. J. Heart Failure 2005; 1:16–18. Russian (Илюхин О. В., Илюхина М. В., Калганова Е. Л. и др. Скорость распространения пульсовой волны в оценке эндотелиальной дисфункции у больных с хронической сердечной недостаточностью ишемической этиологии. Журнал сердечная недостаточность 2005;1:16–18).

8. Ilyukhin O.V, Kalganova E.L., Babkin А.А. et al. Change of elastic properties of the main arteries at sick of an coronary artery disease against therapy atorvastatine and simvastatine. Cardiology, 2005; 12:31–34. Russian (Илюхин О.В., Калганова Е.Л., Бабкин А.А.и др. Изменения упругих свойств магистральных артерий у больных ишемической болезнью сердца на фоне терапии аторвастатином и симвастатином. Кардиология, 2005;12:31–34).

9. Titov V.N. Bases of pathogenetic classification of forms of an arterial hypertonia. Russ J Cardiol, 2009; 2:79–95. Russian (Титов В.Н. Основы патогенетической классификации форм артериальной гипертонии. Российский кардиологический журнал, 2009;2:79–95).

10. Oganov R.G., Glezer M.G., Deev A.D. on behalf of the study participants. Program for Detection of Patients With Ineffective Therapy With b-Adrenoblockers and Comparative Assessment of Efficacy of Addition of Trimetazidine MB or Isosorbide Dinitrate in Stable Angina. ResultsofaRussianStudyParallel. Cardiology 2007,3: 4-13. Russian (Оганов Р.Г., Глезер М.Г., Деев А.Д. от имени участников исследования. Результаты Российского исследования ПАРАЛЛЕЛЬ: Программа по выявлению пациентов с неэффективной терапией бета-адреноблокаторами и сравнительной оценки эффективности добавления к терапии Предуктала МВ или изосорбида динитрата при стабильной стенокардии. Кардиология 2007,3:4–13).

11. Vasjuk J.A, Shalnova S.A., Shkolnik Е.L. et al. Research PRIMA: trimetazidine in treatment of patients with a stable angina pectoris after a myocardial infarction. Cardiology, 2008; 48:10–13. Russian (Васюк Ю.А., Шальнова С.А., Школьник Е.Л. И др. Исследование PRIMA: триметазидин в лечении пациентов со стабильной стенокардией после инфаркта миокарда. Кардиология, 2008;48:10–13).

12. Vasjuk J.A, Yushchuk E.N, Shkolnik Е. L. et al. Comparative research of efficiency trimetazidine МВ and 3 (2,2,2-trimetilgidrazinija) a dihydrate propionate at a chronic heart failure. Therapeutic archive, 2007; 2:51–57. Russian (Васюк Ю. А., Ющук Е. Н., Школьник Е. Л. и др. Сравнительное исследование эффективности триметазидина МВ и 3- (2,2,2-триметилгидразиния) пропионата дигидрата при хронической сердечной недостаточности. Терапевтический архив, 2007;2:51–57).

13. Karpov J.A., Shalnova S.A., Deev A.D. Result of a clinical stage of national program ПРЕМЬЕРА. Progress in cardiology, 2006; 2:12–16. Russian (Карпов Ю.А., Шальнова С.А., Деев А.Д. Результаты клинического этапа национальной программы ПРЕМЬЕРА. Прогресс в кардиологии, 2006;2:12–16).

14. Di Napoli P., Di Giovanni P., Gaeta M.A. et al. Trimetasidine and reduction in mortality and hospitalization in patients with ischemic dilated cardiomyopathy: a post hoc analysis of the Willa Pini d’Abruzzo Trimetasidine Trial.J. Cardiovasc. Pharmacol., 2007; 50:585–589.