New perspectives in the treatment of coronary artery disease in patients with heart arrhythmia and arterial hypertension

The aim of the study was to establish the effectiveness of combined pharmacotherapy of angina pectoris in patients with heart arrhythmia using ranolazine.

Materials and methods. We conducted an open prospective study of 17 patients with coronary artery disease, stable angina pectoris of III–IV functional class. The effectiveness of the therapy was assessed using a survey and a clinical examination after six months of treatment.

Results. At the end of the first month, anginal attacks were not observed in all patients with angina pectoris of III functional class and in 50% of patients with angina pectoris of IV functional class. The same results were obtained during the survey of patients at the end of 6 months of observation. Atrial and ventricular extrasystoles were not observed at the end of the first month in 5 of 9 patients with such rhythm disturbances. At the end of three months of observation, none of the patients noted heart arrhythmia.

Conclusion. Ranolazine is an effective component of antianginal therapy, which significantly improves the patient’s quality of life. The use of ranolazine can be effective in patients with angina accompanied by ventricular and atrial arrhythmia, as it is an anti-anginal drug with proven anti-ischemic and metabolic, as well as anti-arrhythmic effects.

References

1. Knuuti J., Wijns W., Saraste A. et al. (2019) ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology. Eur. Heart J., 41(3): 407–477. doi.org/10.1093/eurheartj/ehz425.
2. Cattaneo M., Halasz G., Cattaneo M.M. et al. (2022) The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina. Front. Cardiovasc. Med., 9: 896042. doi.org/10.3389/fcvm.2022.896042.
3. Ismaiel A., Spinu M., Leucuta D.C. et al. (2022) Anxiety and Depression in Metabolic-Dysfunction-Associated Fatty Liver Disease and Cardiovascular Risk. J. Clin. Med., 11(9): 2488. doi.org/10.3390/jcm11092488.
4. Kofler T., Hess S., Moccetti F. et al. (2020) Efficacy of Ranolazine for Treatment of Coronary Microvascular Dysfunction-A Systematic Review and Meta-analysis of Randomized Trials. Canad. J. Cardiol., 3(1): 101–108. doi.org/10.1016/j.cjco.2020.09.005.
5. Reed M., Kerndt C.C., Gopal S., Nicolas D. (2023) Ranolazine. StatPearls. Treasure Island (FL): StatPearls Publ.
6. Sharp R.P., Patatanian E., Sirajuddin R. (2021) Use of Ranolazine for the Treatment of Coronary Microvascular Dysfunction. Am. J. Cardiovasc. Drugs, 21(5): 513–521. doi.org/10.1007/s40256-020-00462-6.
7. Maulana S., Nuraeni A., Nugraha B.A. (2022) The Potential of Prognostic Biomarkers of Uric Acid Levels in Coronary Heart Disease Among Aged Population: A Scoping Systematic Review of the Latest Cohort Evidence. J. Multidiscip Healthc, 15: 161–173. doi.org/10.2147/JMDH.S340596.
8. Kaplan A., Amin G., Abidi E. et al. (2022) Role of ranolazine in heart failure: From cellular to clinic perspective. Eur. J. Pharmacol., 919: 174787. doi.org/10.1016/j.ejphar.2022.174787.
9. Lovelock J.D., Monasky M.M., Jeong E.M. et al. (2012) Ranolazine improves cardiac dysfunction through modulation of myofilament calcium sensitivity. Circ. Res., 110: 841–850. doi: 10.1161/CIRCRESAHA.111.258251.
10. Cattaneo M., Porretta A.P., Gallino A. (2015) Ranolazine: Drug overview and possible role in primary microvascular angina management. Int. J. Cardiol., 181: 376–381.
11. Putri D.K.S.C., Andrianto A., Al-Farabi M.J. et al. (2023) Efficacy of Ranolazine to Improve Diastolic Performance in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-analysis. Eur. Cardiol., 18: e02. doi: 10.15420/ecr.2022.10.
12. Ghosh G.C., Ghosh R.K., Bandyopadhyay D. et al. (2018) Ranolazine: Multifaceted Role beyond Coronary Artery Disease, a Recent Perspective. Heart Views, 19(3): 88–98. doi.org/10.4103/heartviews.heartviews_18_18.
13. Manolis A., Kallistratos M., Poulimenos L. et al. (2022) Effects of ranolazine on various outcomes in patients with stable angina: an updated meta-analysis. Hellenic J. Cardiol., S1109-9666(22)00176-2. doi: 10.1016/j.hjc.2022.12.002.
14. De Vecchis R., Ariano C., Giasi A., Cioppa C. (2018) Antiarrhythmic effects of ranolazine used both alone for prevention of atrial fibrillation and as an add-on to intravenous amiodarone for its pharmacological cardioversion: a meta-analysis. Minerva Cardioangiol., 66(3): 349–359. doi: 10.23736/S0026-4725.17.04349-3.
15. Rosano G.M.C., Vitale C. (2018) Metabolic Modulation of Cardiac Metabolism in Heart Failure. Card. Fail. Rev., 4(2): 99–103. doi.org/10.15420/cfr.2018.18.2.
16. Volynskyi D., Vakaliuk I. (2019) Use Of Meldonium In The Treatment Of Patients With Coronary Artery Disease And Concomitant Arterial Hypertension. Eureka: Health Sciences, 6(6): 9–14. doi.org/10.21303/2504-5679.2019.001018.
17. Salazar C.A., Flores J.E.B., Espinoza L.E.V. et al. (2017) Ranolazine for stable angina pectoris. Cochrane Database Syst. Rev., 2(2): CD011747. doi: 10.1002/14651858.
18. Zweiker R., Aichinger J., Metzler B. et al. (2019) Ranolazine: impact on quality of life in patients with stable angina pectoris, results from an observational study in Austria — the ARETHA AT study. Wien Klin. Wochenschr., 131(7–8): 165–173. doi: 10.1007/s00508-019-1481-x.
19. Andrievskaya S., Krotenko V., Kolesnik V. (2019) New components of contemporary arrhythmology — the basics of pathogenesis and their clinical justification. Medicine of Ukraine, 16–23. doi: 10.37987/1997-9894.2019.8(234).187158.
20. Leelapatana P., Thongprayoon C., Prasitlumkum N. et al. (2021) Role of Ranolazine in the Prevention and Treatment of Atrial Fibrillation in Patients with Left Ventricular Systolic Dysfunction: A Meta-Analysis of Randomized Clinical Trials. Diseases, 9(2): 31. doi: 10.3390/diseases9020031.