Andrzej Paradowski

Proposed Antiischemic Effects of Trimetazidine in Coronary Diabetic Patients. A Substudy from TRIMPOL-1

Summary. Diabetes mellitus, a disease with a wide prevalence, has major cardiovascular effects, being a risk factor for the development of ischemic heart disease and congestive heart failure. The aim of this open, multicenter study was to assess the antiischemic efficacy and tolerability of trimetazidine, a metabolic agent acting at the myocardial mitochondrial level, in diabetic patients with stable effort angina treated previously with a single conventional antianginal drug. Fifty diabetic patients (mean age 58 years) with proven coronary artery disease, stable effort angina for at least 3 months, and positive, comparable results of two initial treadmill exercise tests separated by a 1-week interval were included in the study. They continued their conventional antianginal monotherapy with a long-acting nitrate, beta-blocker, or calcium channel blocker. After stabilization, 4-week therapy with trimetazidine, three times daily, 20 mg was initiated in combination with previous treatment. The results showed a significant improvement in exercise tolerance (440.2 vs. 383.2 s; P < 0.01), time to 1-mm ST-segment depression (358.3 vs. 301.6 s; P < 0.01), time to onset of anginal pain (400.0 vs. 238.3 s; P < 0.01), and total work (9.39 vs. 8.67 metabolic equivalents, P < 0.01). Maximal ST-segment depression was attenuated compared with baseline (1.82 vs. 1.91 mm). Other findings included a significant decrease in the mean frequency of anginal episodes (3.06 vs. 4.79 per week; P < 0.01) and in mean nitrate consumption (2.29 vs. 4.2 doses/week). These results suggest that trimetazidine may be effective and is well tolerated as combination therapy for diabetic coronary artery disease patients uncontrolled with a single hemodynamic agent.

P-57 Evaluation of Plasma Renin Activity in Acute MI Patients Treated with Primary Percutaneous Coronary Interventions

Aim of Study: Evaluation of plasma renin activity in patients with acute myocardial infarction AMI) treated with primary percutaneous coronary interventions (PCI). We observed 62 pts, (39 man) aged 38 75 yrs with first AMI treated with PCI. Plasma renin activity (PRA) was evaluated on 1st, 3rd and 5th day and 1st and 3rd month after AMI in all pts. Anthropometric parameters: BMI, body weight and body fat concentration, Serum NTproBNP and hsCRP Max TnI concentration, maximal activity of CK and CK-MB were measured within short post-AMI period. Echocardiography with evaluation left ventricles function were performed at 3rd day, 1st and 3rd month after AMI. Cardio-pulmonary exercise test was performed after 3 months of follow-up. Results: Mean value of PRAwas 2.8 at 1st day; 3.4 at 3rd day; 4.5 at 5th day; 4.7 at 1 month, and 3.6 ng/ml/h at 3 months after AMI. Mean valuees of PRA was significantly lower in women than in men only at 1st day (0.9 vs 3.5 ng/ml/h; p = 0.01). Peak value of PRA was observed between 5th day and 1st month after AMI. Values of PRA correlate with serum NTproBNP, body fat concentration, RV diameter and tricuspid annular plane systolic excursion TAPSE. Conclusions: 1. PRA was significantly higher in men than in women at 1st day of acute MI treated with primary PCI. 2. Values of PRA changes within early period after AMI with peak value between 5th day and 1st month after AMI. 3. Values of PRA correlate with serum level of NTproBNP at 1st day of AMI and echocardiography parameters of right ventricle function with 3 month follow up in this group of patients.

P-58 Level of Dehydroepiandrostendione Sulfate in Patients with Acute MI Treated with Primary PCI

Aim of Study: Evaluation of plasma renin activity in patients with acute myocardial infarction AMI) treated with primary percutaneous coronary interventions (PCI). We observed 62 pts, (39 man) aged 38 75 yrs with first AMI treated with PCI. Plasma renin activity (PRA) was evaluated on 1st, 3rd and 5th day and 1st and 3rd month after AMI in all pts. Anthropometric parameters: BMI, body weight and body fat concentration, Serum NTproBNP and hsCRP Max TnI concentration, maximal activity of CK and CK-MB were measured within short post-AMI period. Echocardiography with evaluation left ventricles function were performed at 3rd day, 1st and 3rd month after AMI. Cardio-pulmonary exercise test was performed after 3 months of follow-up. Results: Mean value of PRAwas 2.8 at 1st day; 3.4 at 3rd day; 4.5 at 5th day; 4.7 at 1 month, and 3.6 ng/ml/h at 3 months after AMI. Mean valuees of PRA was significantly lower in women than in men only at 1st day (0.9 vs 3.5 ng/ml/h; p = 0.01). Peak value of PRA was observed between 5th day and 1st month after AMI. Values of PRA correlate with serum NTproBNP, body fat concentration, RV diameter and tricuspid annular plane systolic excursion TAPSE. Conclusions: 1. PRA was significantly higher in men than in women at 1st day of acute MI treated with primary PCI. 2. Values of PRA changes within early period after AMI with peak value between 5th day and 1st month after AMI. 3. Values of PRA correlate with serum level of NTproBNP at 1st day of AMI and echocardiography parameters of right ventricle function with 3 month follow up in this group of patients.