Kober G, Buck T, Sievert H, Vallbracht C
Clinic Nordrhein, Bad Nauheim, Germany.
Eur Heart J. 1992 Aug;13(8):1109-15. doi: 10.1093/oxfordjournals.eurheartj.a060322.
Trimetazidine (TMZ) has recently been shown to improve anginal symptoms without altering haemodynamic variables. A randomized, double-blind, placebo-controlled study was conducted in 20 patients to study the effects of TMZ on the severity of myocardial ischaemia during PTCA of the left anterior descending coronary artery. Five minutes after a first successful dilatation (D0), a control balloon inflation (D1) was performed until onset of ischaemic signs on both the intracoronary (i.c.) and precordial ECG. Two minutes later, patients received either TMZ 6 mg or placebo i.c. Another inflation (D2) was performed 5 min after D1. No differences were found between the two groups regarding responses in heart rate, systemic and i.c. pressures during the study. TMZ decreased the maximum ST-segment shift at D2 compared with D1 (0.8 +/- 0.1 vs 1.4 +/- 0.3 mV, P = 0.023) and delayed its onset (46 +/- 4 vs 36 +/- 5 s, P = 0.024). TMZ also decreased maximum T-wave changes (1.06 +/- 0.24 vs 2.19 +/- 0.3 mV, P = 0.001), and significantly reduced the area under the curve (mv s-1) of the i.c. ST-segment and T-wave changes during balloon inflation (P = 0.042 and P = 0.009 respectively). The placebo had no effect on these parameters. These results support the hypothesis that trimetazidine has a direct anti-ischaemic effect on human myocardial cells.
曲美他嗪（TMZ）最近被证明可改善心绞痛症状，而不改变血流动力学变量。对20例患者进行了一项随机、双盲、安慰剂对照研究，以研究TMZ对左前降支冠状动脉经皮冠状动脉腔内血管成形术（PTCA）期间心肌缺血严重程度的影响。在首次成功扩张（D0）5分钟后，进行对照球囊充盈（D1），直至冠状动脉内（i.c.）和心前区心电图出现缺血征象。两分钟后，患者冠状动脉内注射6 mg TMZ或安慰剂。在D1后5分钟进行另一次充盈（D2）。研究期间，两组在心率、全身和冠状动脉内压力反应方面未发现差异。与D1相比，TMZ使D2时的最大ST段移位降低（0.8±0.1 vs 1.4±0.3 mV，P = 0.023），并延迟了其发作（46±4 vs 36±5秒，P = 0.024）。TMZ还降低了最大T波变化（1.06±0.24 vs 2.19±0.3 mV，P = 0.001），并显著降低了球囊充盈期间冠状动脉内ST段和T波变化的曲线下面积（mv s-1）（分别为P = 0.042和P = 0.009）。安慰剂对这些参数无影响。这些结果支持曲美他嗪对人心肌细胞具有直接抗缺血作用这一假说。
