Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction

Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

doi:10.1007/s10557-016-6676-z

Cited by 17 publications

(11 citation statements)

References 32 publications

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“…. We found that ranolazine did not improve CFR, and other studies have yielded similar findings (23,26,(69)(70)(71). However, some studies indicate that ranolazine may improve the coronary microvascular function by improving angina symptoms (18,72).…”

Section: )supporting

confidence: 78%

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Yong

Tian

Yang

et al. 2020

Front. Cardiovasc. Med.

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This study aims to investigate the impact of cardiovascular medications on the coronary flow reserve (CFR) in patients without obstructive coronary artery disease (CAD).Methods: We searched PubMed, EMBASE, and Cochrane databases from inception to 15 November 2019. Studies were included if they reported CFR from baseline to follow-up after oral drug therapy of patients without obstructive CAD. Data was pooled using random-effects modeling. The primary outcome was change in CFR from baseline to follow-up after oral drug therapy.Results: A total of 46 studies including 845 subjects were included in this study. Relative to baseline, the CFR was improved by angiotensin-converting enzymes (ACEIs), aldosterone receptor antagonists (ARBs) [standard mean difference (SMD): 1.12; 95% CI: 0.77-1.47], and statins treatments (SMD: 0.61; 95%CI: 0.36-0.85). Six to 12 months of calcium channel blocker (CCB) treatments improved CFR (SMD: 1.04; 95% CI: 0.51-1.58). Beta-blocker (SMD: 0.24; 95% CI: −0.39-0.88) and ranolazine treatment (SMD: 0.31; 95% CI: −0.39-1.01) were not associated with improved CFR.Conclusions: Therapy with ACEIs, ARBs, and statins was associated with improved CFR in patients with confirmed or suspicious CMD. CCBs also improved CFR among patients followed for 6-12 months. Beta-blocker and ranolazine had no impact on CFR.

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Section: )supporting

confidence: 78%

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Yong

Tian

Yang

et al. 2020

Front. Cardiovasc. Med.

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“…Numerous studies indicate an increased risk of cardiovascular events in these patients and high costs due to frequent rehospitalization, repeat diagnostic procedures, and medical therapy [ 1 ••, 4 , 5 ]. Approximately one third of patients remain symptomatic in spite of therapeutic interventions, which are often empirical [ 5 , 6 •]. NOCAD angina is associated with depression and decreased quality of life (QoL) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Rehabilitation and Exercise Prescription in Symptomatic Patients with Non-Obstructive Coronary Artery Disease—a Systematic Review

Kissel

Nikoletou

2018

Curr Treat Options Cardio Med

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Purpose of reviewNon-obstructive coronary artery disease (NOCAD) on coronary angiography is a common finding in patients with stable angina. Angina in NOCAD patients is thought to be caused by endothelial dysfunction of the epicardial coronary arteries and/or the microvasculature. Treatment is empiric, and 30% of patients remain symptomatic in spite of therapy. It is well known that physical exercise can improve endothelial function. The goal of this review was to assess the current literature on effects of physical exercise in NOCAD patients with angina. Therefore, a literature search was conducted to March 13, 2018 using the following search terms: syndrome X, microvascular angina, non-obstructive coronary artery disease and exercise training, cardiac rehabilitation, endothelial function. All original publications were included which examined the effect of a cardiac rehabilitation (CR) program or exercise training (ET) on patients with angina and NOCAD.Recent findingsEight studies, of which four were randomized controlled studies, examined 218 participants, 162 in an intervention and 56 in control groups. Most patients were women (97.7%). Exercise programs varied from 8 weeks to 4 months at moderate intensity and some included relaxation therapy. The studies examined the effect of CR on exercise capacity, quality of life (QoL), and perfusion defects. CR increased exercise capacity, oxygen uptake, symptom severity, and QoL. Myocardial perfusion improved.SummaryCR appears to be beneficial in symptomatic patients with NOCAD, improving exercise capacity and QoL and reducing severity of symptoms and myocardial perfusion defects. Data is limited to a small number of predominantly female patients. Further larger trials are warranted to determine the optimal rehabilitation protocols and define its long-term benefits.

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“…ACS based on the pathological basis of rupture or invasion of atherosclerotic plaque and subsequent complete or incomplete occlusive thrombosis included the acute T-segment elevation myocardial infarction, acute non-ST-segment elevation myocardial infarction and unstable angina (16). Cardiac syndrome X, also known as microvascular angina, is defined as angina pectoris caused by abnormalities of the small coronary arteries, and is characterized by the patient experiencing chest pain during exercise and evidence of myocardial ischemia with a non-invasive stress test (17). With these patients the coronary angiography can appear normal (18).…”

Section: Methodsmentioning

confidence: 99%

Association between RAGE variants and the susceptibility to atherosclerotic lesions in Chinese Han population

et al. 2019

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Receptor for advanced glycation end products (RAGE) is a major proinflammatory receptor and its role in atherosclerosis has only been emphasized recently. Increasing evidence has demonstrated an association between RAGE and the susceptibility to atherosclerosis development. Therefore, the role of RAGE in atherogenesis and the possible impact of genetic variations in RAGE on the atherosclerotic process in subjects with coronary artery disease (CAD) was investigated in the present study. The RAGE expression in carotid specimens was analyzed by immunohistochemistry and sequence variations of the RAGE gene selected from the Hapmap database were also screened. The plasma levels of S100 calcium binding protein B (S100B) were determined by ELISA. Immunohistochemical staining of tissue samples demonstrated an increased RAGE expression in atherosclerotic carotid plaques compared with that in normal arteries. Furthermore, compared with the corresponding wild-type genotype, the rs2269422 single-nucleotide polymorphism of RAGE was associated with the susceptibility of patients with CAD to atherosclerosis. Furthermore, reverse transcription polymerase chain reaction and western blot analyses indicated increased coronary artery RAGE mRNA levels and protein expression, respectively, in CAD patients vs. control subjects. Furthermore, the plasma levels of S100B in CAD patients that were carriers of the AA/AT genotype of the rs2269422 variant of RAGE was increased compared with that in TT genotype carriers; as this was also identified in control subjects, it may not be CAD-specific. The RAGE rs2269422 variant is therefore significantly associated with an increased occurrence of CAD in the present Han Chinese population. Thus, RAGE variants significantly impact the risk of CAD in Han Chinese subjects.

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Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction

Cited by 17 publications

References 32 publications

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

Cardiac Rehabilitation and Exercise Prescription in Symptomatic Patients with Non-Obstructive Coronary Artery Disease—a Systematic Review

Association between RAGE variants and the susceptibility to atherosclerotic lesions in Chinese Han population

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