Ranolazine effective for angina in ischaemic patients
Ranolazine improves angina and myocardial perfusion in patients with signs of ischaemia with coronary flow reserve (CFR) <2.5 and without obstructive coronary artery disease (CAD), reports a new study.
A total of 81 patients (mean age 54.77±10.19 years; 98.8 percent female) were enrolled in whom the mean baseline CFR was 2.69±0.65. More than half (56.8 percent; n=46) had CFR values ≥2.5, while the remaining 35 (43.2 percent) had CFR <2.5.
Ranolazine significantly improved angina, measured using the Seattle Angina Questionnaire (SAQ-7), relative to placebo in patients with CFR <2.5 (change, 5.76±11.51 vs –0.86±13.45; p=0.028). A similar effect was observed on SAQ angina frequency (change, 9.14±17.55 vs –0.29±14.24 p=0.0073).
Notably, no such effects were observed for patients with CRF ≥2.5. Ranolazine likewise had no significant effect on physical limitation, angina stability, quality of life and treatment satisfaction.
Researchers also observed a significant effect of ranolazine on global myocardial perfusion reserve index (MPRI), which significantly improved in those with CFR <2.5 (change: 0.12±0.58) but decreased in patients with CFR ≥2.5 (change: –0.15±0.44; t test p=0.02). The same was true for midventricular MPRI (change: 0.27±0.68 and –0.11±0.5, respectively; t test p=0.005).
There was also a direct association between elevated MPRI values and improvements in symptoms, suggesting a link between angina and ischaemia, said researchers. The present findings also showed the potential of late sodium channel inhibition as a management option in these patients.