Effects of Ranolazine on Coronary Flow Reserve in Symptomatic Diabetic Patients and CAD
Status:
Completed
Trial end date:
2015-12-01
Target enrollment:
Participant gender:
Summary
Coronary vascular dysfunction is highly prevalent among patients with known or suspected
Coronary Artery Disease (CAD)1, increases the severity of inducible myocardial ischemia
(beyond the effects of upstream coronary obstruction)2, and identifies patients at high risk
for serious adverse events, including cardiac death1, 3-5. Diabetic patients without known
CAD with impaired coronary vascular function show a risk of cardiac death comparable to, and
possibly higher, than that for non-diabetic patients with known CAD10. In the setting of
increased oxygen demand, coronary vasodilator dysfunction can upset the supply-demand
relationship and lead to myocardial ischemia, subclinical left ventricular dysfunction
(diastolic and systolic), and symptoms.
The significance of microvascular coronary dysfunction is increasingly recognized as invasive
and non-invasive (PET) methods of quantifying CFR become available.
Importantly, current treatment strategies for obstructive CAD, such as percutaneous coronary
intervention with angioplasty and stenting, are not helpful in microvascular disease.
Similarly, mortality-altering treatments for systolic heart failure, such as angiotensin
converting enzyme inhibitors, have not been beneficial in treating diastolic dysfunction.