心肌能量代谢治疗进曲美他嗪的临床应用.pptVIP

* * * * * * * * * * * * * * * * * * * * * 目的： 评价万爽力?治疗血运重建后患者的心绞痛和心肌确血的疗效 入组患者： TPIMPOL II（一项多中心双盲随机安慰剂对照试验，共入组426名稳定性心绞痛患者）中的亚组，该亚组共94名患者，既往有因冠状动脉疾病而行血运重建术的病史，术后仍在接受美托洛尔的治疗，但在术后随访的第6个月时出现再发心绞痛症状。 试验设计： 将这些患者随机分组，在接受?-受体阻滞制治疗的基础上给予万爽力?或安慰剂治疗12周。对运动试验参数、临床疗效和安全性进行评估。 * 翻译摘要： 目的：在标准治疗的基础上联合曲美他嗪已被证明可改善左心衰竭患者的左室(LV)功能。这项研究的目的是通过非侵入性的在体31P -核磁共振光谱(31P - MRS)方法评价曲美他嗪对心衰患者左室心肌磷酸腺苷三磷酸(PCr/ATP)比率的影响。 方法和结果：本随机，双盲，交叉研究共入选12例心力衰竭患者，并分为安慰剂或美他嗪(20 mg t.i.d.)两组分两期各治疗90天。每个阶段治疗结束时，所有患者接受运动试验，二维超声心动图及MRS检查，并收集和评估纽约心脏协会(NYHA)分级，射血分数(EF)，最大脉压及全身代谢当量(METs)等指标。PCr和ATP的相对浓度通过心肌31PMRS测定。曲美他嗪治疗的患者组，NYHA分级从3.04 ±0.26降低至2.45 ±0.52(p= 0.005)，而EF(34 ±10 vs. 39 ±10％，P均= 0.03)和METS(从7.44 ±1.84增加至8.78 ±2.72，P=0.03)均显著增加。安慰剂组平均PCr/ATP的比值为1.35 ±0.33，曲美他嗪组为1.80 ±0.50，增加了33％(P=0.03)。 结论：曲美他嗪可改善心衰患者心功能分级及左心室功能。该疗效与本研究观察到的曲美他嗪介导的PCR / ATP比值升高有关，后者升高表明心肌高能磷酸盐储备增加。 Aims The addition of trimetazidine to standard treatment has been shown to improve left ventricular (LV) function in patients with heart failure. The aim of this study is to non-invasively assess, by means of in vivo 31P-magnetic resonance spectroscopy (31P-MRS), the effects of trimetazidine on LV cardiac phosphocreatine and adenosine triphosphate (PCr/ATP) ratio in patients with heart failure. Methods and results Twelve heart failure patients were randomized in a double-blind, cross-over study to placebo or trimetazidine (20 mg t.i.d.) for two periods of 90 days. At the end of each period, all patients underwent exercise testing, 2D echocardiography, and MRS. New York Heart Association (NYHA) class, ejection fraction (EF), maximal rate–pressure product, and metabolic equivalent system (METS) were evaluated. Relative concentrations of PCr and ATP were determined by cardiac 31P-MRS. On trimetazidine, NYHA class decreased from 3.04+0.26 to 2.45+0.52 (P ?0.005), whereas EF (34+10 vs. 39+10%, P ?0.03) and METS (from 7.44+1.84 to 8.78+2.72, P ?0.03) increased. The mean cardiac PCr/ATP ratio was 1.35+0.33 with placebo, but was increased by 33% t