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Resolution of angina pectoris and improvement of the coronary flow reserve after ranolazine treatment in a woman with isolated impaired coronary microcirculation.

Santoro A, Schiano Lomoriello V, Santoro C, Muscariello R, Galderisi M - Case Rep Cardiol (2013)

Bottom Line: The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug.Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion.The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade.

View Article: PubMed Central - PubMed

Affiliation: Cardioangiology with CCU, Department of Clinical and Experimental Medicine, Federico II University Hospital, 80131 Naples, Italy.

ABSTRACT
In a 61-year-old woman with well controlled arterial hypertension, hypercholesterolemia, and smoke and suffering from recurrent angina pectoris despite angiographically normal epicardial coronary vessels and maximal therapy, the replacement of nitrates with novel antiangina drug ranolazine, after 6-month therapy, induced a complete relief of angina and a relevant rising of the transthoracic Doppler-derived coronary flow reserve (CFR). The present clinical case underlines therefore how in patients with chronic ischemic heart disease without epicardial coronary stenosis ranolazine can induce an improvement till the complete solution of the angina symptoms and a substantial increase of CFR as expression of the enhancement of the microvascular coronary function. The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug. Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion. The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade.

No MeSH data available.


Related in: MedlinePlus

CFR evaluation after 6-month therapy with ranolazine.
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Related In: Results  -  Collection


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fig4: CFR evaluation after 6-month therapy with ranolazine.

Mentions: Woman, 61 years, affected by a long lasting, well controlled arterial systemic hypertension, hypercholesterolemia, and smoke (20 cigarettes daily). In the last 3 years she presented several angina episodes (5-6 per week). At June 2010 she underwent a coronary angiography showing the absence of significant stenosis of the epicardial coronary arteries. The patient was treated with bisoprolol 10 mg oid, valsartan 320 mg oid, isosorbide-5-mononitrate 60 mg oid, acetylsalicylic acid (ASA) 100 mg oid, and rosuvastatin 20 mg oid. Even after this therapy the symptoms kept affecting the patient. In December 2010, she underwent a pharmacologic stress echocardiography with dipyridamole (0.84 mg/Kg in 6 minutes, “fast” protocol) to evaluate at the same time the coronary flow reserve (CFR) and the regional wall motion according to the stress echo recommendations of the European Association of Echocardiography (Figure 1) [6]. In the presence of angina pectoris and significant repolarization phase abnormalities of the surface ECG (Figure 2) the stress echo showed an impaired CFR (<2) (Figure 3) without regional wall motion alteration. According to the results of the test an isolated microvascular coronary dysfunction was diagnosed (reduced CFR + normal regional wall motion) [6]. Accordingly, given that the symptoms were still present, it was decided to replace the isosorbide-5-mononitrate with ranolazine, for the first 2 weeks 375 mg bid followed by 500 mg bid. At the third month from the beginning of the therapy (March 2011) the patient referred a substantial reduction of the angina pectoris rate through the week (from 5-6 to 2 per week) and the complete resolution of the symptoms in May 2011. In June 2011 new pharmacologic stress echo was repeated. Again in the absence of regional wall motion abnormalities, the test showed a completely normal CFR with a relevant improvement in comparison with the previously performed test (from 1.85 to 4.00) (Figure 4). Of interest, the patient did not exhibit any kind of symptoms during and after the stress echo and the surface ECG was totally normal (Figure 5). The patient is yet under treatment with ranolazine (combined with bisoprolol, valsartan, ASA, and rosuvastatin) and she is completely free of symptoms of angina pectoris.


Resolution of angina pectoris and improvement of the coronary flow reserve after ranolazine treatment in a woman with isolated impaired coronary microcirculation.

Santoro A, Schiano Lomoriello V, Santoro C, Muscariello R, Galderisi M - Case Rep Cardiol (2013)

CFR evaluation after 6-month therapy with ranolazine.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4008276&req=5

fig4: CFR evaluation after 6-month therapy with ranolazine.
Mentions: Woman, 61 years, affected by a long lasting, well controlled arterial systemic hypertension, hypercholesterolemia, and smoke (20 cigarettes daily). In the last 3 years she presented several angina episodes (5-6 per week). At June 2010 she underwent a coronary angiography showing the absence of significant stenosis of the epicardial coronary arteries. The patient was treated with bisoprolol 10 mg oid, valsartan 320 mg oid, isosorbide-5-mononitrate 60 mg oid, acetylsalicylic acid (ASA) 100 mg oid, and rosuvastatin 20 mg oid. Even after this therapy the symptoms kept affecting the patient. In December 2010, she underwent a pharmacologic stress echocardiography with dipyridamole (0.84 mg/Kg in 6 minutes, “fast” protocol) to evaluate at the same time the coronary flow reserve (CFR) and the regional wall motion according to the stress echo recommendations of the European Association of Echocardiography (Figure 1) [6]. In the presence of angina pectoris and significant repolarization phase abnormalities of the surface ECG (Figure 2) the stress echo showed an impaired CFR (<2) (Figure 3) without regional wall motion alteration. According to the results of the test an isolated microvascular coronary dysfunction was diagnosed (reduced CFR + normal regional wall motion) [6]. Accordingly, given that the symptoms were still present, it was decided to replace the isosorbide-5-mononitrate with ranolazine, for the first 2 weeks 375 mg bid followed by 500 mg bid. At the third month from the beginning of the therapy (March 2011) the patient referred a substantial reduction of the angina pectoris rate through the week (from 5-6 to 2 per week) and the complete resolution of the symptoms in May 2011. In June 2011 new pharmacologic stress echo was repeated. Again in the absence of regional wall motion abnormalities, the test showed a completely normal CFR with a relevant improvement in comparison with the previously performed test (from 1.85 to 4.00) (Figure 4). Of interest, the patient did not exhibit any kind of symptoms during and after the stress echo and the surface ECG was totally normal (Figure 5). The patient is yet under treatment with ranolazine (combined with bisoprolol, valsartan, ASA, and rosuvastatin) and she is completely free of symptoms of angina pectoris.

Bottom Line: The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug.Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion.The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade.

View Article: PubMed Central - PubMed

Affiliation: Cardioangiology with CCU, Department of Clinical and Experimental Medicine, Federico II University Hospital, 80131 Naples, Italy.

ABSTRACT
In a 61-year-old woman with well controlled arterial hypertension, hypercholesterolemia, and smoke and suffering from recurrent angina pectoris despite angiographically normal epicardial coronary vessels and maximal therapy, the replacement of nitrates with novel antiangina drug ranolazine, after 6-month therapy, induced a complete relief of angina and a relevant rising of the transthoracic Doppler-derived coronary flow reserve (CFR). The present clinical case underlines therefore how in patients with chronic ischemic heart disease without epicardial coronary stenosis ranolazine can induce an improvement till the complete solution of the angina symptoms and a substantial increase of CFR as expression of the enhancement of the microvascular coronary function. The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug. Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion. The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade.

No MeSH data available.


Related in: MedlinePlus