Рецепт. 2019; : 633-641
Фармакотерапевтические возможности коррекции рефрактерной стенокардии
Аннотация
По решению Европейского общества кардиологов (European Society of Cardiology, ESC) и Американской кардиологической ассоциации (American Heart Association, AHA) в схему лечения стабильной стенокардии включен ранолазин. Лекарственное средство представляет собой селективный ингибитор позднего тока ионов натрия. Препятствуя внутриклеточной перегрузке ионами натрия и, соответственно, ионами кальция, ранолазин способствует улучшению диастолического расслабления миокарда. Благодаря этому действию устраняется нарушение релаксации кардиомиоцитов, улучшается миокардиальная перфузия и уменьшается ишемия миокарда, что клинически проявляется облегчением течения стенокардии: приступы становятся реже, возрастает переносимость физической нагрузки, снижается потребность в пероральном нитроглицерине. Отсутствие влияния ранолазина на основные гемодинамические параметры – артериальное давление и частоту сердечных сокращений – позволяет, при необходимости, комбинировать препарат с другими лекарственными средствами, использующимися в лечении ишемической болезни сердца. При стенокардии препарат преимущественно используется в комбинации с бета-адреноблокаторами, блокаторами кальциевых каналов, нитратами. Особую категорию пациентов составляют пациенты с рефрактерной стенокардией, у которых на фоне адекватно подобранной фармакотерапии и невозможности выполнения реваскуляризации миокарда сохраняются симптомы заболевания. Диагноз рефрактерной стенокардии может быть выставлен не только при отказе в реваскуляризации, но и при возобновлении стенокардии после уже выполненного вмешательства. В статье представлены результаты клинических исследований ранолазина у пациентов с рефрактерной стенокардией. Установлена клиническая эффективность и безопасность включения ранолазина в схемы лечения пациентов с данной патологией. По данным исследований, ранолазин хорошо переносится и наиболее частыми побочными эффектами являются головокружение, головная боль, запор, тошнота.
Список литературы
1. Gorohova S., Ryazhenov V., Gorohov V. (2014) Farmakoekonomicheskaya otsenka primeneniya ranolazina u rossiiskih patsientov so stenokardiei [Pharmacoeconomic evaluation of the use of ranolazine in Russian patients with angina pectoris]. Meditsinskie tehnologii. Otsenka i vibor, 2, pp. 60–65.
2. Gurevich M., Agababyan D., Kuz’menko N. (2014) Mehanizm deistviya i primenenie ranolazina pri ishemicheskoi bolezni serdtsa i fibrillyatsii predserdii [The mechanism of action and the use of ranolazine in coronary heart disease and atrial fibrillation]. RMZH, 31, pp. 21–33.
3. Karpov YU. (2011) Lechenie stabil’noi stenokardii – prioritet medikamentoznoi terapii [Treatment of stable angina pectoris is a priority for drug therapy]. RMZH, 26, pp. 1593–1598.
4. Lupanov V. (2014) Novie Evropeiskie metodicheskie rekomendatsii 2013 [New European methodological recommendations 2013 on the treatment of stable coronary heart disease]. RMZH, 2, pp. 98–105.
5. Lupanov V. (2012) Ranolazin pri ishemicheskoi bolezni serdtsa [Ranolazine in coronary heart disease]. Ratsional’naya farmakoterapiya v kardiologii, 8 (1), pp. 103–109.
6. Arora R.R., Chou T.M., Jain D. (1999) The Multicenter study of enhanced external counterpulsation (MUST-EECP): Effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J. Am. Coll. Cardiol., vol. 33, no 7, pp. 1833–1840.
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9. Chaitman B., Skettino S., Parker J. (2004) Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol., vol. 43 (8), pp. 1375–1382.
10. Detre K., Guo P., Holubkov R. (1999) Coronary revascularization in diabetic patients: a comparison of the randomized and observational components of the bypass angioplasty revascularization investigation (BARI). Circulation, vol. 99, pp. 633–640.
11. ESC guidelines on the management of stable coronary artery disease (2013) The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013. Eur Heart J., vol. 34 (38), pp. 2949–3003.
12. Hautvast R., Brouwer J., DeJongste M. (1998) Effect of spinal cord stimulation on heart rate variability and myocardial ischemia in patients with chroni intractable angina pectoris – a prospective ambulatory electrocardiographic study. Clin. Cardiol., vol. 21, pp. 33–38.
13. Kourlaba G., Vlachopoulos Ch., Parissis J. (2015) Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study. BMC Health Services Research, vol. 15, p. 566.
14. Lаwson W., Hui J., Kennard E. (2006) Two-years outcomes in patients with mild refractory angina treated with enhanced external counterpulsation. Clin. Cardiol., vol. 29, no 2, pp. 69–73.
15. Maier L. (2009) A novel mechanism for treatment of angina, arrhythmias, and diastolic dysfunction: inhibition of late I (Na) using ranolazine. J Cardiovasc Pharmacol, vol. 54, no 4, pp. 279–286.
16. Mannheimer C., Eliasson T., Augustinsson L. (1998) Electrical stimulation versus coronary artery by-pass surgery in severe angina pectoris: the ESBY study. Circulation, vol. 97, pp. 1157–1163.
17. Mannheimer C., Camici P., Chester M. (2002) The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur. Heart. J., vol. 23, pp. 355–370.
18. Michels G., Kochanek M., Hoppe U.C. (2010) Ranolazine – an additional anti-anginal drug. Dtsch Med Wochenschr, vol. 135, no 41, pp. 2037–2040.
19. Morrow D., Scirica B., Chaitman B. (2009) Evaluation of the glycometabolic effects of ranolazine in patients with and without diabetes mellitus in the MERLIN-TIMI 36 randomized controlled trial. Circulation, vol. 119 (15), pp. 2032–9.
20. Reddy B.M., Weintraub H.S., Schwartzbard A.Z. (2010) Ranolazine. A New Approach to Treating an Old Problem. Tex Heart Inst J., vol. 37, no 6, pp. 641–647.
21. Scirica B., Morrow D., Hod H. (2007) Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation, vol. 116 (15), pp. 1647–52.
22. Stone P., Gratsiansky N., Blokhin A. (2006) Antianginal efficacy of ranolazine when added to treatment with amlodipine: the ERICA (Efficacy of Ranolazine in Chronic Angina) trial. J Am Coll Cardiol., vol. 48 (3), pp. 566–575.
23. Trufa A., Newby L., Melloni C. (2011) Extended-release ranolazine: critical evaluation of its use in stable angina. Vasc Health Risk Manag., vol. 7, pp. 536–539.
24. Yang E., Barsness G., Gersh B. (2004) Current and future treatment strategies for refractory angina. Mayo Clinic. Proc., vol. 79, no 10, pp. 1284–1292.
Recipe. 2019; : 633-641
Pharmacotherapeutic Possibilities of Refractory Angina’s Correction
Abstract
By decision of the European Society of Cardiology (ESC) and the American Heart Association (AHA), ranolazine is included in the treatment of stable angina. The drug is a selective inhibitor of late current sodium ions. By preventing intracellular overload with sodium ions and, accordingly, calcium ions, ranolazine helps to improve the diastolic relaxation of the myocardium. Due to this action, the disturbance of cardiomyocyte relaxation is eliminated, myocardial perfusion improves and myocardial ischemia decreases, which is clinically manifested by relief of angina pectoris: attacks become less common, exercise tolerance increases, the need for oral nitroglycerin decreases. Ranolazine does not influence on the main hemodynamic parameters – blood pressure and heart rate. Its allows, if necessary, to combine the drug with other drugs using in the treatment of ischemic heart disease. In case of angina pectoris, ranolazine is mainly used in combination with betaadrenoblockers, calcium channel blockers, and nitrates. A special category of patients is patients with refractory angina pectoris. Such patients have symptoms of the disease on the background of adequately selected pharmacotherapy and the inability to perform myocardial revascularization. The diagnosis of refractory angina can be made not only if the revascularization is denied, but also when angina is resumed after the intervention has already been performed. The results of clinical studies of ranolazine in patients with refractory angina are presents in this article. The clinical efficacy and safety of the inclusion of ranolazine in the treatment regimen of patients with refractory angina pectoris has been established. According to research, ranolazine is well tolerated and the most frequent side effects are dizziness, headache, constipation, nausea.
References
1. Gorohova S., Ryazhenov V., Gorohov V. (2014) Farmakoekonomicheskaya otsenka primeneniya ranolazina u rossiiskih patsientov so stenokardiei [Pharmacoeconomic evaluation of the use of ranolazine in Russian patients with angina pectoris]. Meditsinskie tehnologii. Otsenka i vibor, 2, pp. 60–65.
2. Gurevich M., Agababyan D., Kuz’menko N. (2014) Mehanizm deistviya i primenenie ranolazina pri ishemicheskoi bolezni serdtsa i fibrillyatsii predserdii [The mechanism of action and the use of ranolazine in coronary heart disease and atrial fibrillation]. RMZH, 31, pp. 21–33.
3. Karpov YU. (2011) Lechenie stabil’noi stenokardii – prioritet medikamentoznoi terapii [Treatment of stable angina pectoris is a priority for drug therapy]. RMZH, 26, pp. 1593–1598.
4. Lupanov V. (2014) Novie Evropeiskie metodicheskie rekomendatsii 2013 [New European methodological recommendations 2013 on the treatment of stable coronary heart disease]. RMZH, 2, pp. 98–105.
5. Lupanov V. (2012) Ranolazin pri ishemicheskoi bolezni serdtsa [Ranolazine in coronary heart disease]. Ratsional’naya farmakoterapiya v kardiologii, 8 (1), pp. 103–109.
6. Arora R.R., Chou T.M., Jain D. (1999) The Multicenter study of enhanced external counterpulsation (MUST-EECP): Effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J. Am. Coll. Cardiol., vol. 33, no 7, pp. 1833–1840.
7. Berger P. (2004) Ranolazine and other antianginal therapies in the era of the drug-eluting stent. JAMA, vol. 291 (3), pp. 365–367.
8. Chaitman B., Pepine C., Parker J. (2004) Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA, vol. 291 (3), pp. 309–316.
9. Chaitman B., Skettino S., Parker J. (2004) Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol., vol. 43 (8), pp. 1375–1382.
10. Detre K., Guo P., Holubkov R. (1999) Coronary revascularization in diabetic patients: a comparison of the randomized and observational components of the bypass angioplasty revascularization investigation (BARI). Circulation, vol. 99, pp. 633–640.
11. ESC guidelines on the management of stable coronary artery disease (2013) The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013. Eur Heart J., vol. 34 (38), pp. 2949–3003.
12. Hautvast R., Brouwer J., DeJongste M. (1998) Effect of spinal cord stimulation on heart rate variability and myocardial ischemia in patients with chroni intractable angina pectoris – a prospective ambulatory electrocardiographic study. Clin. Cardiol., vol. 21, pp. 33–38.
13. Kourlaba G., Vlachopoulos Ch., Parissis J. (2015) Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study. BMC Health Services Research, vol. 15, p. 566.
14. Lawson W., Hui J., Kennard E. (2006) Two-years outcomes in patients with mild refractory angina treated with enhanced external counterpulsation. Clin. Cardiol., vol. 29, no 2, pp. 69–73.
15. Maier L. (2009) A novel mechanism for treatment of angina, arrhythmias, and diastolic dysfunction: inhibition of late I (Na) using ranolazine. J Cardiovasc Pharmacol, vol. 54, no 4, pp. 279–286.
16. Mannheimer C., Eliasson T., Augustinsson L. (1998) Electrical stimulation versus coronary artery by-pass surgery in severe angina pectoris: the ESBY study. Circulation, vol. 97, pp. 1157–1163.
17. Mannheimer C., Camici P., Chester M. (2002) The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur. Heart. J., vol. 23, pp. 355–370.
18. Michels G., Kochanek M., Hoppe U.C. (2010) Ranolazine – an additional anti-anginal drug. Dtsch Med Wochenschr, vol. 135, no 41, pp. 2037–2040.
19. Morrow D., Scirica B., Chaitman B. (2009) Evaluation of the glycometabolic effects of ranolazine in patients with and without diabetes mellitus in the MERLIN-TIMI 36 randomized controlled trial. Circulation, vol. 119 (15), pp. 2032–9.
20. Reddy B.M., Weintraub H.S., Schwartzbard A.Z. (2010) Ranolazine. A New Approach to Treating an Old Problem. Tex Heart Inst J., vol. 37, no 6, pp. 641–647.
21. Scirica B., Morrow D., Hod H. (2007) Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation, vol. 116 (15), pp. 1647–52.
22. Stone P., Gratsiansky N., Blokhin A. (2006) Antianginal efficacy of ranolazine when added to treatment with amlodipine: the ERICA (Efficacy of Ranolazine in Chronic Angina) trial. J Am Coll Cardiol., vol. 48 (3), pp. 566–575.
23. Trufa A., Newby L., Melloni C. (2011) Extended-release ranolazine: critical evaluation of its use in stable angina. Vasc Health Risk Manag., vol. 7, pp. 536–539.
24. Yang E., Barsness G., Gersh B. (2004) Current and future treatment strategies for refractory angina. Mayo Clinic. Proc., vol. 79, no 10, pp. 1284–1292.
