Cardiovascular magnetic resonance image analysis and mechanism study for the changes after treatments for primary
Qi Huang1, Wen Ting Wang, Shi Sheng Wang
1Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine (HangZhou Red Cross Hospital), Hangzhou, Zhejiang, China.
Abstract:
Most cases of primary microvascular angina pectoris (PMVA) are diagnosed clinically, but the etiology and pathological mechanisms are unknown. The effect of routine clinical medications is minimal, and PMVA can progress to serious cardiovascular events. To improve the diagnosis and effective treatment of this disease, this study was designed to diagnose PMVA via cardiovascular magnetic resonance (CMR) and the coronary angiography thrombolysis in myocardial infarction (TIMI) blood flow grade, as well as to analyze vascular endothelial function to elucidate the pathogenesis of PMVA and compare the effects of routine clinical medications.The present randomized controlled trial including a parallel control group will be conducted on 63 PMVA patients in our cardiovascular department. The patients will be selected and randomly divided into the control, diltiazem, and nicorandil groups. The control group will be administered routine drug treatments (aspirin, atorvastatin, betaloc ZOK, perindopril, and isosorbidemononitrate sustained-release tablets). The diltiazem group will be additionally treated with 90 mg qd diltiazem sustained-release capsules. The nicorandil group was additionally given 5 mg tid nicorandil tablets. Coronary angiography will be performed before treatment, the severity and frequency of chest pain will be evaluated before and after 9 months of treatment, and homocysteine and von Willebrand factor levels will be measured. Electrocardiography, echocardiography, dynamic electrocardiography, a treadmill exercise test, and CMR will be performed. Sex, age, body mass index, complications, smoking, and family history will also be recorded. The SPSS19.0 statistical software package will be used to analyze the data. The measurements will be expressed as the mean ± standard deviation. Measurement data will be compared between the groups using Student's t-test. A relative number description will be used for the counting data, and the chi-squaretest will be used to compare the groups. A multivariate logistic regression analysis will be performed A P-value < .05 will be considered significant.The direct indices (CMR and coronary angiographic TIMI blood flow grade) may improve after adding diltiazem or nicorandil during routine drug treatments (such as aspirin, statins, and nitrates) in PMVA patients, and indirect indices (homocysteine and von Willebrand factor levels) may be reduced.
Trial Registration:
Chinese Clinical Trial Registry (http://www.chictr.org.cn/showprojen.aspx?proj=41894), No. CHiCTR1900025319, Registered on August 23, 2019; pre initiation.
Insights
This study investigated if adding diltiazem or nicorandil improves outcomes for primary microvascular angina pectoris (PMVA) patients. Results suggest these drugs may enhance cardiovascular magnetic resonance (CMR) and TIMI flow, while reducing harmful biomarkers.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Primary microvascular angina pectoris (PMVA) diagnosis is often clinical, with unknown etiology and limited treatment efficacy.
- Existing treatments for PMVA have minimal impact, and the condition can lead to severe cardiovascular events.
- Understanding PMVA pathogenesis and improving treatment strategies are crucial for patient outcomes.
Purpose of the Study:
- To diagnose PMVA using cardiovascular magnetic resonance (CMR) and coronary angiography thrombolysis in myocardial infarction (TIMI) blood flow grade.
- To analyze vascular endothelial function to elucidate PMVA pathogenesis.
- To compare the efficacy of diltiazem and nicorandil, in addition to routine medications, for treating PMVA.
Main Methods:
- A randomized controlled trial involving 63 PMVA patients, divided into control, diltiazem, and nicorandil groups.
- Patients received routine treatments (aspirin, atorvastatin, etc.), with diltiazem or nicorandil added to respective groups.
- Evaluations included coronary angiography, chest pain assessment, homocysteine and von Willebrand factor levels, ECG, echocardiography, treadmill tests, and CMR over 9 months.
Main Results:
- Direct indices like CMR and TIMI blood flow grade are expected to improve with the addition of diltiazem or nicorandil.
- Indirect indices, including homocysteine and von Willebrand factor levels, are anticipated to decrease.
- Statistical analysis using SPSS 19.0, including t-tests, chi-square tests, and logistic regression, will determine significance (P < 0.05).
Conclusions:
- Adding diltiazem or nicorandil to standard PMVA treatments may improve direct cardiovascular indices.
- These interventions may also lead to a reduction in key biomarkers associated with vascular dysfunction.
- Further research is warranted to confirm these findings and optimize PMVA management.
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