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Aspirin plus verapamil relieves angina and perfusion abnormalities in patients with coronary microvascular
Rafael Brolio Pavão1, Henrique Turin Moreira1, Antonio Oswaldo Pintya1
1Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Divisão de Cardiologia, Ribeirão Preto, SP, Brasil.
Insights
Verapamil plus aspirin significantly reduced ischemia and improved quality of life in patients with Chagas disease cardiomyopathy and coronary microvascular dysfunction. This safe, low-cost treatment offers a new therapeutic option for this patient group.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Chronic cardiomyopathy of Chagas disease (CCCD) often involves secondary coronary microvascular dysfunction (CMD).
- Currently, no evidence-based therapies exist for CMD in CCCD patients.
- This study investigates a potential treatment for CMD in this population.
Purpose of the Study:
- To evaluate the impact of verapamil plus aspirin on symptoms and myocardial perfusion in patients with CCCD and CMD.
- To assess the safety and efficacy of this combined treatment.
Main Methods:
- Thirty-two patients with confirmed CCCD and myocardial ischemia underwent assessment.
- Patients received either oral verapamil plus aspirin (n=26) or placebo (n=6) for 3 months.
- Clinical evaluation, quality of life, and myocardial perfusion scintigraphy (MPS) were measured before and after treatment.
Main Results:
- Verapamil plus aspirin significantly reduced the ischemic index summed difference score (SDS) in MPS by 55.6%.
- 77% of treated participants showed reduced ischemia, with 10 experiencing no detectable ischemia post-treatment.
- Improvements in quality of life were observed in the treatment group, with no changes in the placebo group.
Conclusions:
- A 3-month treatment with verapamil plus aspirin is safe and effective for patients with CCCD and CMD.
- This low-cost therapy significantly reduces ischemic burden, alleviates symptoms, and enhances quality of life.
Introduction:
Most patients with chronic cardiomyopathy of Chagas disease (CCCD) harbor a secondary cause of coronary microvascular dysfunction (CMD), for which there is no evidence-based therapy. We evaluated the impact of verapamil plus aspirin on symptoms and perfusion abnormalities in patients with CCCD and CMD.
Methods:
Consecutive patients with angina pectoris, who had neither coronary artery obstructions nor moderate-severe left ventricular dysfunction (left ventricular ejection fraction > 40%) despite showing wall motion abnormalities on ventriculography, were referred for invasive angiography and tested for Chagas disease. Thirty-two patients with confirmed CCCD and ischemia on stress-rest SPECT myocardial perfusion scintigraphy (MPS) were included. Clinical evaluation, quality of life (EQ-5D/ Seattle Angina Questionnaire), and MPS were assessed before and after 3 months of treatment with oral verapamil plus aspirin (n=26) or placebo (n=6).
Results:
The mean patient age was 64 years, and 18 (56%) were female. The ischemic index summed difference score (SDS) in MPS was significantly reduced by 55.6% after aspirin+verapamil treatment. A decrease in SDS was observed in 20 (77%) participants, and in 10 participants, no more ischemia could be detected. Enhancements in quality of life were also detected. No change in symptoms or MPS was observed in the placebo group.
Conclusions:
This low-cost 3-month treatment for patients diagnosed with CCCD and CMD was safe and resulted in a 55.6% reduction in ischemic burden, symptomatic improvement, and better quality of life.
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