ABSTRACT
Patients having angina with normal epicardial coronary arteries are often considered to have coronary microvascular dysfunction that may result in coronary slow flow. Delayed Coronary Sinus Filling Time (CSFT) may represent transit time through coronary microcirculation.We evaluated CSFT in patients having angina with normal epicardial coronary arteries and compared it with control population. Methods: 31 patients having definite angina or probable angina with positive exercise tolerance test with normal epicardial coronary arteries in coronary angiogram (CAG) were included in the study group. 31 patients having normal epicardial coronary arteries in CAG during preoperative evaluation before surgical treatment for valvular and congenital heart diseases were in control group. CSFT, TIMI (Thrombolysis In Myocardial Infarction) frame count, cTIMI (Corrected TIMI) frame count and TMP (TIMI Myocardial Perfusion) score were assessed in CAG of both group and compared between groups. Results: Patients’ Mean±SD of age in study and control group were 48.84±9.50years and 46.71±5.53years respectively with no significant difference (p=0.569) and there was female preponderance (55% and 65%) in both groups. CSFT was significantly prolonged in study group (4.22±0.71sec vs. 3.65±0.25sec, P value 0.001) but TIMI frame count, cTIMI and TMP showed no significant difference between two groups (25.71±5.74 vs. 26.74±3.81, p= 0.552; 14.76±3.6 vs. 15.4±2.56, p=0.449; 2.54±0.5 vs. 2.61±0.49, p=0.326; respectively). Conclusion: We concluded that CSFT was significantly prolonged in patients having angina with normal epicardial coronary arteries which might be a marker for diagnosis of coronary microvascular disease.
ABSTRACT
ackground: Aims: To compare the anti ischaemic efficiency of antianginal thepapy using a combination of metoprolol, Long acting nitrate (LAN) & trimetazidine/ranolazine in patients with stable effort angina with impaired LV function. Methods: The study enrolled 200 patients (male & female) aged 55-70 years with stable effort induced angina (functional class II and III angina) documented coronary artery disease. When the patients taking metoprolol 50mg twice daily& LAN 2.6 mg twice daily continued to have angina, after that 120 patients received an additional 35mg of trimetazidine twice a day or ranolazine 500 mg twice daily & 80 patients had double antianginal thepapy –methoprolol & LAN. Treadmill exercise test and transthoracic echocardiography were performed at weeks (WO, & W12). Results: After 12 weeks, treadmill exercise showed there were significantly greater improvements in the triple antianginal group (metoprolol+ LAN+ trimetazidine / ranolazine): time to I mm ST segment depression, maximum ST segment depression, mean weekly number of angina attacks, mean weekly nitrate consumption, & grade of angina pain and transthoracic echocardiogram showed improved left ventricular systolic and diastolic function. Conclusion: Triple antianginal thepapy with metoprolol+ LAN+ trimetazidine/ ranolazine combinations produced significant improvement in exercise stress test & the symptoms of angina relative to double antianginal therapy(metoprolol+ LAN) as well as improved left ventricular function.