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Benefits of adding a energetic agent to  - blockers to achieve optimal reduction of angina.

Benefits of adding a energetic agent to  - blockers to achieve optimal reduction of angina. Review of the main studies. Is coronary obstruction the only player in ischemic heart disease?. Sambuceti G . Eur J Nucl Med Mol Imaging . 2005;32:385-388.

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Benefits of adding a energetic agent to  - blockers to achieve optimal reduction of angina.

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  1. Benefits of adding a energetic agent to -blockers to achieve optimal reduction of angina. Review of the main studies

  2. Is coronary obstruction the only player in ischemic heart disease? Sambuceti G.Eur J Nucl Med Mol Imaging. 2005;32:385-388.

  3. Is coronary obstruction the only player in ischemic heart disease? Cheng VY, et al. Circulation. 2011;124:2423-2432.

  4. Myocardialischemiaismultifactorial Marzilli M, et al. J Am Coll Cardiol. 2012;60:951-956.

  5. Ischemiais an energydeficiency Marzilli M, et al. J Am Coll Cardiol 2012;60:951–6.

  6. Increased energy in the ischemic heart Fragasso G, et al. Eur Heart J. 2006;27:942-948.

  7. Act on both sides of the cellular energy balance • To protect the cells from ischemia, the energy supply needs to remain greater than the energy demand. Cellular energy balance

  8. 450 500 450 400 400 350 350 300 300 5 4 4 3 3 2 2 Trimetazidine 1 Placebo 1 0 0 Proven antianginal efficacywith-blockers Time to 1-mm ST depression Time to onset of angina P<0.01 P<0.01 n=426 Stable angina patientsAll on metoprolol (50 mg/day) Time (s) Time (s) NS NS W0 W12 W0 W12 Angina attacks/week (n) Nitrate use / week (n) NS P<0.01 NS P<0.01 Mean nitrate use / week (n) Angina attacks W0 W12 W0 W12 Szwed H, et al. TRIMPOL II Eur Heart J. 2001;22:2367-2374.

  9. Proven antianginal efficacy with -blockers n=53 Stable angina patients uncontrolled with Propranolol 40 mg/day Michaelides AP, et al. Clin Drug Invest. 1997;13:8-14.

  10. Proven antianginal efficacy with -blockers Nesukay E, et al. ESC 2013. Abstract 86728.

  11. Conclusions • Chronic ischemic heart disease (IHD) is still a significant • clinical burden • IHD results from a number of mechanisms • To ensure optimal management of IHD on top of -blockers, it is essential to address the energetic origin of ischemia • Trimetazidine MR is an effective drug to use in combination with β-blockers to relieve angina effectively.

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