心力衰竭能量是代谢治疗.pptVIP

曲美他嗪临床相关研究 慢性稳定型心绞痛 Sellier et al 1986 Dalla-Volta et al 1990 Detry et al (TEMS) 1994 Michaelides et al 1997 TRIMPOL,1997 胡大一等 2000 Ciapponi et al 2006 左心功能不全 Lu et al 1998 Belardinelli et al 2001 Vitale 2004 朱文玲等2005 Fragasso et al 2006 PTCA Kober et al 1993 Birand et al 1997 Steg et al 2001 Polonski et al 2002 CABG Febiani et al 1992 Vedrinne et al 1996 Tunerir et al 1999 Iskesen et al 2006 糖尿病性冠心病 Szwed et al (TRIMPOL I)1999 Fragasso et al 2003 Rosano et al 2003 Padial et al 2005 老年冠心病 Rosano et al 2003 Kolbel et al (TIGER) 2003 Vitale et al 2004 缺血性心肌病 Di Napoli et al 2005 El-Kady et al 2005 雷诺嗪：抗心绞痛研究 （ERICA Study） Ranolazine extended-release 500 mg bid (1 week) then 1000 mg bidn = 281 Placebon = 284 History of CAD* Stable angina (≥3 angina episodes/week) Amlodipine 10 mg/dayN = 565 7 weeks Primary efficacy variable:Angina frequency (weekly average) RandomizedDouble-blind Evaluation of Ranolazine In Chronic Angina *≥60% stenosis, previous MI, and/or stress-induced perfusion defect Stone PH et al. J Am Coll Cardiol. 2006;48:566-75. 雷诺嗪：减少心绞痛和硝酸酯类用量 Placebo Ranolazine 1000 mg bid Nitroglycerin use Angina episodes P = 0.028 P = 0.014 0 1 2 3 4 5 6 Baseline Week 7 Baseline Week 7 Mean number per week Stone PH et al. J Am Coll Cardiol. 2006;48:566-75. UA/NSTEMI (Moderate-High Risk) RanolazineIV to PO Placebo Matched IV/PO RANDOMIZE (1:1) Double-blind Holter Long-term Follow-up (Median 348 Days) Standard Therapy N = 6560 Morrow DA et al. JAMA 2007; 297: 1775-83 雷诺嗪： 改善UA/NSTEMI患者预后的研究 Fragakis N et al. Am J Cardiol. 2012 May 21. [Epub ahead of print 雷诺嗪：抗房颤作用 与胺碘酮联用，增加房颤转复成功率 L-卡尼汀是脂肪酸代谢的必需辅助因子，它能将心肌细胞胞浆中堆积的FFA转入线粒体，促进心肌由CHF时的无氧糖酵解重新回到脂肪酸氧化，使心肌能量代谢恢复正常。 心肌代谢疗法—底物的调节 促进脂肪酸氧化： L-卡尼丁 肉毒碱缺乏 脂肪酸β-氧化障碍 游离脂肪酸增多 能量产生障碍 脂肪酸代谢产物堆积 Effect of L-carnitine on glucose oxidation rates in control and diabetic rat heart hearts before and after ischaemia. Values are the mea