Preductal MR - Od desetiletých klinických zkušeností s léčbou u stabilní anginy pectoris k novým perspektivám

Souhrn

Trimetazidin je řadu let znám jako účinný antianginózní lék „přátelský k pacientům“. Poslední studie potvrdily účinnost trimetazidinu u stabilní ischemické choroby srdeční a ukázaly, že může být přínosem také u jiných chorob srdce. Trimetazidin má, jak bylo publikováno, příznivý vliv na prognózu pacientů, kteří přežili infarkt myokardu s elevací úseku ST, a vykazuje kardioprotektivní účinek u pacientů, kteří prodělali ischémii s následnou reperfuzí, a podstupují PCI nebo aortokoronární bypass. Ovšem nejzajímavější perspektivy se objevují v oblasti srdečního selhání, kde byl zjištěn příznivý účinek trimetazidinu na kvalitu života a prognózu pacientů.

Klíčová slova: akutní koronární syndromy / angina pectoris / CABG / srdeční selhání / PCI / trimetazidin

Abstract

Trimetazidine has been known for years as being an effective, ‘‘patient friendly’’, anti-anginal agent. Recent studies using the modified release formulation (Vastarel MR) have confirmed the efficacy of trimetazidine in stable ischemic heart disease and suggested that it can be beneficial in a number of cardiac conditions. Trimetazidine has been reported to have a favourable impact on the prognosis of patients surviving an ST elevation myocardial infarction and to exert a cardioprotective effect in patients undergoing an ischemia reperfusion sequence, such as patients submitted to PCI or CABG procedures. However, the most exciting perspectives come from the heart failure area, where a beneficial effect has been reported on quality of life and prognosis.

Key words: acute coronary syndromes / angina pectoris / CABG / heart failure / PCI / trimetazidine

LITERATURA

1. Murray CJL, Lopez AD. The Global Burden of Disease. Cambridge, MA: Harvard School of Public Health; 1996.

2. Jaswal JS, Cadette JJ, Lopaschuk GD. Optimizing cardiac energy metabolism: a novel therapeutic intervention for ischemic heart disease. Heart Metab 2008;38:5–14.

3. Opie L. Proof that glucose–insulin–potassium provides metabolic protection of ischaemic myocardium? Lancet 1999; 353: 768–769.

4. Kantor PF, Lucien A, Kozak R, Lopaschuk GD. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long-chain 3-ketoacyl coenzyme A thiolase. Circ Res 2000;86:580–588.

5. Fragasso G, Persenghin G, Francesco De Cobelli F, et al. Effects of metabolic modulation by trimetazidine on left ventricular function and phosphocreatine/adenosine triphosphate ratioin patients with heart failure. EurHeart J 2006; 27: 942–948.

6. Detry JM, Sellier P, Pennaforte S, Cokkinos D, Dargie H, Mathes P. Trimetazidine: a new concept in the treatment of angina. Comparison with propranolol in patients with stable angina. Br J Clin Pharmacol 1994;37:279–288.

7. Szwed H, Sadowski Z, Elikowski W, et al. Combination treatment in stable eff ort angina using trimetazidine and metoprolol. Results of a randomized, doubleblind, multicentre study (TRIMPOL II). Eur Heart J 2001;22:2267–2274.

8. Chazov EI, Lepakchin VK, Zharova EA, et al. Trimetazidine in Angina Combination Therapy – the TACT Study: trimetazidine versus conventional treatment in patients with stable angina pectoris in a randomized, placebo-controlled, multicenter study. Am J Ther 2005;12:35–42.

9. Danchin N, Marzilli M, Parkhomenko A, Ribeiro J. Trimetazidine in the treatment of stable angina pectoris: a metaanalysis of randomized, controlled clinical trials. Paris, Servier International (Data on fi le).

10. Iyengar SS, Rosano GMC. Effect of antianginal drugs in stable angina on predicted mortality risk after surviving a myocardial infarction. Am J Cardiovasc Drugs 2009;9: 293–297.

11. Doenst T, Bugger H, Schwarzer M, Faerber G, Borger MA, Mohr FW. Three good reasons for heart surgeons to understand cardiac metabolism. Eur J Cardiothorac Surg 2008; 33:862–871.

12. Kober G, Buck T, Sievert H, Vallbracht C. Myocardial protection during percutaneous transluminal coronary angioplasty: effects of trimetazidine. Eur Heart J 1992;13:1109–1115.

13. Poloński L, Dec I, Wojnar R, Wilczek K. Trimetazidine limits the effects of myocardial ischemia during percutaneous coronary angioplasty. Curr Med Res Opin 2002;18:389–396.

14. Onbasili AO, Yeniceriglu Y, Agaoglu P, et al. Trimetazidine in the prevention of contrast-induced nephropathy after coronary procedures. Heart 2007;93:698–702.

15. Bonello L, Sbragia P, Amabile N, et al. Protective effect of an acute oral loading dose of trimetazidine on myocardial injury following percutaneous coronary intervention. Heart 2007; 93:703–707.

16. Labrou A, Giannoglou G, Zioutas D, Fragakis N, Katsaris G, Louridas G. Trimetazidine administration minimizes myocardial damage and improves left ventricular function after percutaneous coronary intervention. Am J Cardiovasc Drugs 2007;7:143–150.

17. Fabiani JN, Ponzio O, Emerit I, et al. Cardioprotective effect of trimetazidine during coronary artery graft surgery. J Cardiovasc Surg 1992;33:486–491.

18. Tünerir B, Colak O, Alatas¸ O, Beşogul Y, Kural T, Aslan R. Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting. Ann Thorac Surg. 1999;68:2173–2176.

19. Iskesen I, Kurdal AD, Eserdag M, Cerrahoglu M, Sirin BH. Trimetazidine may protect the myocardium during cardiac surgery. Heart Surg Forum 2009;12:E175–E179.

20. Neubauer S. The failing heart – an engine out of fuel. N Engl J Med 2007;356:1140–1151.

21. Taegtmeyer H. Cardiac metabolism as a target for the treatment of heart failure. Circulation 2004;110:894–896.

22. Brottier L, Barat JL, Combe C, Boussens B, Bonnet J, Bricaud H. Therapeutic value of cardioprotective agent in patients with severe ischemic cardiomyopathy. Eur Heart J 1990; 11:207–212.

23. Belardinelli R, Purcaro A. Effects of trimetazidine on the contractile response of chronically dysfunctional myocardium to low-dose dobutamide in ischaemic cardiomyopathy. Eur Heart J 2001;22:2164–2170.

24. Fragasso G, Palloshi A, Puccetti P, et al. A randomized clinical trial of trimetazidine, a partial free fatty acid oxidation inhibitor, in heart failure patients. J Am Coll Cardiol 2006; 48:992–998.

25. Di Napoli P, Taccardi AA, Barsotti A. Long-term cardioprotective action of trimetazidine and potential effect on the infl ammatory process in patients with ischaemic dilated cardiomyopathy. Heart 2005;91:161–165.

26. Di Napoli P, Di Giovanni P, Gaeta MA, Taccardi AA, Barsotti A. Trimetazidine and reduction in mortality and hospitalization in patients with ischemic dilated cardiomyopathy. A post hoc analysis of the Villa Pini D’Abbruzio Trimetazidine Trial. J Cardiovasc Pharmacol 2007;50:585–589.

27. El-Kady E, El-Sabban K, Gabaly M, Sabry A, Abdel-Hady S. Effects of trimetazidine on myocardial perfusion and the contractile response of chronically dysfunctional myocardium in ischemic cardiomyopathy. A 24-month study. Am J Cardiovasc Drugs 2005;5:271–278.

28. Tuunanen H, Engblom E, Naum A, et al. Trimetazidine, a metabolic modulator, has cardiac and extracardiac benefits in idiopathic dilated cardiomyopathy. Circulation 2008;118: 1250–1258.

29. Gunes Y, Guntekin U, Tuncer M, Sahin M. Improved left and right ventricular functions with trimetazidine in patients with heart failure: a tissue Doppler study. Heart Vessels 2009; 24:277–282.

Zdroj: Medicína po promoci