Efficacy of trimetazidine and sulodexide in patients with microvascular angina

Abstract

Background. Despite the progress in the diagnostics of microvascular angina (MA) there is no effective pathogenetic therapy. Aim. To study the effect of trimetazidine and sulodexide as a part of drug therapy on clinical manifestations, exercise tolerance, quality of life, myocardial perfusion and endothelial function in patients with MA. Material and methods. Patients with MA (n=90) were included into the study and randomized into 3 groups. Patients of the first group (control; n=30) received standard antianginal therapy. The second group (treatment group; n=30) received standard therapy and sulodexide (1 ampoule of 600 IU intramuscularly for 10 days, then 1 capsule of 250 IU, 2 times a day). Patients of the third group (treatment group; n=30) received standard therapy and trimetazidine with modified release 35 mg 2 times a day. Evaluation of angina symptoms and quality of life by the Seattle Questionnaire, stress (treadmill) test, positron emission tomography (baseline, adenosine test, cold-pressor test), peripheral arterial tonometry were performed at baseline and 3 months after starting treatment. Results. After 3 months of treatment a significant improvement in symptoms, quality of life and results of stress-test were observed only among patients of treatment groups, most pronounced in the 3rd group. Patients of this group showed an increase in myocardial blood flow >25% according to positron emission tomography (from 86.2±29.7 to 129.5±41.0 ml/100g/min, p<0.05 for anterior interventricular artery; from 93.3±30.5 to 131.7±32.7 ml/100g/min, p<0.05 for circumflex artery; from 91.3±30.4 to 135.9±41.1 ml/100g/min, p<0.05 for right coronary artery) and a significant increase in coronary reserve, as well as an improvement in endothelial function: an increase in coronary reserve of endothelium-dependent vasodilation, an increase in the reactive hyperemia index according to peripheral arterial tonometry (from 1.44±0.14 to 1.73±0.18, p<0.001). Conclusion. Improvement of the clinical picture, quality of life, myocardial perfusion, and endothelial function was observed among microvascular angina patients who were treated with standard antianginal therapy and trimetazidine.