Turkiye Klinikleri Cardiovascular Sciences

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Sol Ventrikül Disfonksiyonu Olan Stabil Anjina Pektorisli Hastalarda İvabradin, Nebivolol, Trimetazidin ve Ranolazinin Tedavi Etkinlik Karşılaştırması
Comparison of the Safety and Effificacy of Ivabradine, Nebivolol, Trimetazidine and Ranolazine Therapies in the Treatment of Stable Angina Pectoris Patients with Left Ventricular Dysfunction
Rasim KUTLUa, Mehmet Erdem MEMETOĞLUb, Murataliev Tolkun MURATALİEVc
aKardiyoloji AD, Giresun Üniversitesi Tıp Fakültesi, Giresun
bKalp ve Damar Cerrahisi AD, Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, İstanbul
cKardiyoloji AD, Kırgızistan Devlet Tıp Akademisi, Ulusal Kardiyoloji Tıp Enstitüsü, Bişkek, Kırgızistan
Turkiye Klinikleri J Cardiovasc Sci. 2016;28(2):49-60
doi: 10.5336/cardiosci.2016-51984
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada, sol ventrikül ejeksiyon fraksiyonu (LVEF) <%40 sistolik ve diyastolik disfonksiyonu olan stabil anjina pektoris (SAP)?li hastalarda, ivabradin, nebivolol, trimetazidin ve ranolazinin tedavide etkinliklerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Kardiyoloji polikliniğimize başvuran toplam 140 hastada; ivabradin, nebivolol, trimetazidin ve ranolazinin antianjinal, antiiskemik, antitaşikardik, LVEF, metabolik eş değer (MET), diyastolik parametreler üzerine etkinlik karşılaştırmaları yapıldı. Ayrıca bu hastaların tedavi sonrası Seattle SAP anketi ile yaşam kaliteleri ölçüldü. Hastaların tedavi süresince hastaneye yatış oranları hesaplandı. Ayrıca ivabradin, nebivolol, trimetazidin ve ranolazinin ilaç etkileşimi, güvenliliği ve yan etki profili incelendi. Bulgular: Çalışmaya dâhil ettigimiz 138 (%99) hasta miyokard infarktüsü geçirmiş, 138 (%99) hastanın koroner anjiyografileri yapılmış, 137 (%98) hastaya koroner arter baypas cerrahisi önerilmiş ve 131 (%94) hastaya koroner arter baypas cerrahisi uygulanmıştır. Edindiğimiz sonuçlara göre, her grup semptomatik olarak yaşam kalitesinde düzelmeler göstermekle beraber, ilaçlar arasında tedavi enginliği açısından gruplar arası değişim istatistiksel olarak anlamlı bulunmadı. Hastaların tedavi öncesi ve altı aylık takip sürecinde LVEF karşılaştırması yapıldı. İstatistiksel olarak anlamlı bulunmasa da nebivolol (%3), ivabradin (%3), trimetazidin (%1), ranolazin gruplarında (%2) olarak düzelme gözlendi. Sol ventrikül ejeksiyon fraksiyonunda belirgin bir artış olmadı (p<0,05). Hastaların, gruplar arası hastaneye yatış oranları karşılaştırıldı; nebivolol, ivabradin kullanan hastalarda anlamlı; trimetazidin ve ranolazin kullanan hastalarda istatistiksel olarak anlamsız bulundu. Tedavi öncesi ve sonrasında gruplar arası yapılan karşılaştırmada, mevcut diyastolik indekslerde; nebivolol, ivabradin kullanan hastalarda anlamlı; trimetazidin ve ranolazin kullanan hastalarda istatistiksel olarak anlamsız bulundu. Efor testi sonucuna göre yapılan MET analizi sonucuna göre; nebivolol, ivabradin, ranolazin ve trimetazidin kullanan hastalarda MET değerindeki değişim istatistiksel olarak anlamlı bulundu. Tedavi öncesi ve altı aylık periyodik takip sonucuna göre; nebivolol ve ivabradin kullanan hastalarda anlamlı, trimetazidin ve ranolazin kullanan hastalarda anlamsız değişiklikler gözlendi. Sonuç: Nebivolol, ivabradinin sol ventrikül sistolik ve diyastolik disfonksiyonu olan SAP'lı hastalarda antiiskemik, antianjinal, antitaşikardik etkinlik açısından değerlendirilebilir. Trimetazidin ve ranolazin, sol ventriküler sistolik-diyastolik disfonksiyonu olmayan hastalarda antiiskemik ve antianjinal ilaç olarak güvenle kullanılabilir.

Anahtar Kelimeler: Nebivolol; ivabradin; trimetazidin; ranolazin; koroner arter hastalığı; anjina, stabil; kalp yetersizliği, sistolik; kalp yetersizliği, diyastolik
ABSTRACT
 Objective: The goal of this study is to examine the mono effects of ivabradine, nebivolol, trimetazidine and ranolazine in those patients with stable angina pectoris, whose left ventricular ejection fraction (LVEF) is 40% and below. Material and Methods: The comparative effects of ivabradine, nebivolol, trimetazidine and ranolazine on anti-anginal, anti-ischemic, anti-tachycardiac, LVEF, metabolic equivalent task (MET), and diastolic function parameters is performed. Moreover, the life quality of these patients was measured using Seattle SAP (SAQ) survey. The ratio of hospital admission during their treatment was calculated. The drug interaction, reliability and side effect profile of ivabradine, nebivolol, trimetazidine and ranolazine were examined. Results: According to the data, 138 (99%) patients post myocardial infarction and apply coronary angiographies, recommended 137 (98%) patients in coronary artery bypass surgery and 131 (94%) patients applied. While each group displayed symptomatic improvements in life quality, there was no comparative advantage among the groups in terms of drug interaction. The patients were compared in terms of their LVEF before and 6 months after the treatment. The following measures were acquired; nebivolol (3%), ivabradine (3%), trimetazidine (1%), ranolazine (2%). Improvement in LVEF is not significant at (p<0.05). The admission of the patients into hospital was compared intra group. Each group displayed reduced number of hospital admission. This change was significant with patients who use nabivolol, ivabradine and was insignificant with patients who used trimetazidine and ranolazine. In comparing the pre and posttreatment groups a meaningful improvement in existing diastolic indexes was observed. According to this, those patients who have used nebivolol, ivabradine it was found significant at and those who have used trimetazidine and ranolazine it was found insignificant at. Those groups, which we included in the study based on effort tests-analysis of MET, showed improvement. This change in MET level was found statistically significant at in groups that used nebivolol ivabradine ranolazine and trimetazidine. In pretreatment patients that we observed in six month periods the effects of groups on patients' cardiac rhythm was looked to. According to this, the change in patients who used nebivolol and ivabradine was found significant at and in those patients who used trimetazidine and ranolazine the change in cardiac rhythm was found statistically insignificant. Conclusion: It can be assumed that nebivolol, ivabradine, trimetazidine and ranolazine are safe agents in terms of their anti-anginal effects in patients with SAP, who has left ventricle systolic and diastolic dysfunction and nebivolol, ivabradine can safely be used to drop the cardiac rhythm.

Keywords: Nebivolol; ivabradine; trimetazidine; ranolazine; coronary artery disease; angina, stable; heart failure, systolic; heart failure, diastolic

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