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Dajun Huang,1,* Yanwei Li,1,* Xiaoyan Zheng,2,3,* Jinming Hu,1 Hanzhang Tang,1 Yongjun Yin,1 Zhou Wu,1 Lingqiu Kong1 1Department of Cardiovascular Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 2Clinical Research Center for Acupuncture and Moxibustion in Sichuan province, Sichuan JinXin Xinan Women’s and Children’s Hospital, Chengdu, People’s Republic of China; 3Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lingqiu Kong; Zhou Wu, Department of Cardiovascular Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Address: No. 39 Shi’er Qiao Road, Chengdu, Sichuan, 610023, People’s Republic of China, Email klq521@163.com; 1209293923@qq.comObjective: This systematic review aimed to compare the efficacy of various acupuncture dosages for Chronic Stable Angina (CSA) using randomized controlled trials (RCTs), addressing the unclear relationship between dosage and effectiveness despite acupuncture’s potential.Methods: We searched eight bibliographic databases from inception to October 31, 2024, evaluating RCTs comparing acupuncture to placebo or standard care for CSA patients, focusing on angina attack frequency as the primary outcome. Studies were categorized into high (HDG), moderate (MDG), and low (LDG) dosage groups based on acupuncture characteristics: the number of acupoints, total sessions, frequency per week, and the need for “Deqi”.Results: Of the 807 citations screened, 16 studies (1240 patients) were included: 3 studies in LDG, 10 in MDG, and 3 in HDG. Acupuncture significantly reduced angina attacks compared to placebo (SMD, − 0.51; 95% CI [− 0.77, − 0.25], P = 0.0001, I2=62%), and standard care (SMD, − 1.25, 95% CI [− 1.89, − 0.61], P = 0.00001, I2=92%) without increasing adverse events. MDG showed a notable difference in reducing angina attacks (SMD, − 0.60, 95% CI [− 0.91, − 0.29], P = 0.001, I2=60%) while LDG and HDG did not. There is no difference in adverse events between groups. The evidence quality ranged from very low to moderate, and the results should be cautiously applied.Conclusion: Acupuncture therapy effectively and safely alleviates CSA symptoms. Moderate dosage demonstrated the potential for better effects in reducing symptoms, suggesting optimal dosage considerations for future treatments.Prospero Registration Number: CRD42022321547.Keywords: acupuncture, chronic stable angina, dose-related, effectiveness, meta-analysis

Abstract Background Chronic remote ischemic conditioning (CRIC) has been shown to improve myocardial ischemia in experimental animal studies; however, its effectiveness in patients with chronic stable angina (CSA) has not been investigated. We conducted a proof-of-concept study to investigate the efficacy and safety of a six-month CRIC treatment in patients with CSA. Methods The EARLY-MYO-CSA trial was a prospective, randomized, controlled trial evaluating the CRIC treatment in patients with CSA with persistent angina pectoris despite receiving ≥ 3-month guideline-recommended optimal medical therapy. The CRIC and control groups received CRIC (at 200 mmHg) or sham CRIC (at 60 mmHg) intervention for 6 months, respectively. The primary endpoint was the 6-month change of myocardial flow reserve (MFR) on single-photon emission computed tomography. The secondary endpoints were changes in rest and stress myocardial blood flow (MBF), angina severity according to the Canadian Cardiovascular Society (CCS) classification, the Seattle Angina Questionnaire (SAQ), and a 6-min walk test (6-MWT). Results Among 220 randomized CSA patients, 208 (105 in the CRIC group, and 103 in the control group) completed the treatment and endpoint assessments. The mean change in MFR was significantly greater in the CRIC group than in the control group (0.27 ± 0.38 vs. − 0.04 ± 0.25; P

Background: In clinical practice management of patients with intermediate coronary artery disease efficiently without costing a lot of money has a value to this therapeutic dilemma, especially in patients presented to the catheterization laboratory without prior functional assessment. Methods: A decision model to compare between the cost of FFR-guided coronary interventions and angiographically guided interventions was done. Intermediate coronary lesions in each patient were assessed twice by using the two methods leading to two decisions for each patient. A comparison between the costs of the two decisions was made. Results: FFR-guided coronary intervention saved 63 stents in 122 lesions in 50 patients. The estimated cost of FFR-guided strategy per patient ranged from 25.000 Egyptian pound (EP) to 45.000 EP with mean value of 26.860+4.500 EP. Whereas the estimated cost of coronary angiography guided strategy per patient ranged from 15.000 EP to 61.000 EP with mean value of 31.740+12.960 EP. Conclusions: Measuring FFR is cost-effective in chronic stable angina especially in diabetic patients with multivessel disease. [ABSTRACT FROM AUTHOR]

Background: Chronic remote ischemic conditioning (CRIC) has been shown to improve myocardial ischemia in experimental animal studies; however, its effectiveness in patients with chronic stable angina (CSA) has not been investigated. We conducted a proof-of-concept study to investigate the efficacy and safety of a six-month CRIC treatment in patients with CSA. Methods: The EARLY-MYO-CSA trial was a prospective, randomized, controlled trial evaluating the CRIC treatment in patients with CSA with persistent angina pectoris despite receiving ≥ 3-month guideline-recommended optimal medical therapy. The CRIC and control groups received CRIC (at 200 mmHg) or sham CRIC (at 60 mmHg) intervention for 6 months, respectively. The primary endpoint was the 6-month change of myocardial flow reserve (MFR) on single-photon emission computed tomography. The secondary endpoints were changes in rest and stress myocardial blood flow (MBF), angina severity according to the Canadian Cardiovascular Society (CCS) classification, the Seattle Angina Questionnaire (SAQ), and a 6-min walk test (6-MWT). Results: Among 220 randomized CSA patients, 208 (105 in the CRIC group, and 103 in the control group) completed the treatment and endpoint assessments. The mean change in MFR was significantly greater in the CRIC group than in the control group (0.27 ± 0.38 vs. − 0.04 ± 0.25; P < 0.001). MFR increased from 1.33 ± 0.48 at baseline to 1.61 ± 0.53 (P < 0.001) in the CRIC group; however, a similar increase was not seen in the control group (1.35 ± 0.45 at baseline and 1.31 ± 0.44 at follow-up, P = 0.757). CRIC treatment, when compared with controls, demonstrated improvements in angina symptoms assessed by CCS classification (60.0% vs. 14.6%, P < 0.001), all SAQ dimensions scores (P < 0.001), and 6-MWT distances (440 [400–523] vs. 420 [330–475] m, P = 0.016). The incidence of major adverse cardiovascular events was similar between the groups. Conclusions: CSA patients benefit from 6-month CRIC treatment with improvements in MFR, angina symptoms, and exercise performance. This treatment is well-tolerated and can be recommended for symptom relief in this clinical population. Trial registration: [chictr.org.cn], identifier [ChiCTR2000038649]. [ABSTRACT FROM AUTHOR]

Background: A lot has been investigated about how trimetazidine (TMZ); a metabolic modifier works at molecular level, however very little is known about how well that translates into mechanistic benefit at LV muscular level. This study was done to evaluate the effects of trimetazidine on the LV mechanics in patients of chronic stable angina. Material & Methods: Hospital based observational study, we followed 40 patients of chronic stable angina on conventional optimal medical therapy (OMT). LV mechanical indices including 2D Global Longitudinal Strain (GLS),4D Global Circumferential Strain (GCS),4D Global Area Strain (GAS), 4D Global Radial Strain (GRS), LVEF, E/A, E/e' were measured at baseline and compared 1 month after addition of TMZ to OMT. Results: The mean 2D GLS at baseline was - 17.36 ± 3.09%, which improved to -18.33 ± 3.13% on follow up (P=0.001). The mean 4D GCS at baseline was -6.87 ± 3.41%, and -8.52 ± 2.69% on follow up (P= 0.003). The mean 4D GAS at baseline was-12.40 ± 5.90% vs -14.02 ± 4.38% on follow up (P= 0.017). The mean 4D GRS at baseline was 16.50 ± 7.81% vs 18.00 ± 6.76% on follow up, P =0.091(NS). The mean LVEF improved from 55.67 ± 5.46 at baseline to 57.62 ± 5.15 on follow up after 1month on TMZ therapy (P=0.001). The mean E/A value at baseline was 1.14 ± 0.39, which changed to 1.04 ±0.24 on follow up (P=0.038). The mean E/e' value at baseline was 8.91 ± 2.50, which improved to 8.14 ±2.17 on follow up (P=0.008). Conclusion: TMZ has beneficial effects on the LV Mechanistic indices when added over and above the conventional OMT in patients of chronic stable angina. [ABSTRACT FROM AUTHOR]

This study aimed to assess the holistic value of Danhong injection (DHI) for treating chronic stable angina (CSA) and to identify the therapeutic characteristics of DHI. The holistic value of DHI was assessed using a well-established evaluation index system including 34 criteria based on the Multi-criteria decision analysis (MCDA) model. Each criterion was rated by seven experts based on an evidence matrix comprising a literature review on DHI for treating CSA. The overall value of DHI for the treatment of CSA was evaluated by aggregating these performance scores and predetermined weights. Additionally, the contributions of each domain and criterion to the overall value estimate were calculated. Uncertainty was explored using an online retest and intra-rater correlation coefficient (ICC). We found that the comprehensive value estimate of DHI for treating CSA was 80.18 points. The domain of "safety and risk management" was the strongest contributor to the final estimated value (30.37), followed by "effectiveness" (23.75). The criteria "size of population affected by disease" (3.79), "risk control of toxic medicinal materials" (4.38), "comparative non-medical costs" (1.14), "clarity of the mechanism of drug action" (0.6), "sustainability of medicinal materials resources" (1.91) and "patient compliance" (4.59) were found to be the most significant contributors to the overall value estimate across the 6 evaluation domains. The initial scores for DHI over the two rounds showed good consistency across panelists (ICC = 0.886 [0.858–0.909]). Compared with standard treatment alone, DHI was perceived as being at a "good level" intervention. [ABSTRACT FROM AUTHOR]

Background: To treat coronary artery disease, PCI is a well-established method. Its efficacy in treating symptoms is widely known. In patients with baseline intact left ventricular function, the impact of PCI on systolic and diastolic function is uncertain. We postulated that individuals with chronic stable angina may have impaired regional contractile performance and that PCI would have the potential to enhance ventricular systolic and diastolic function following successful coronary angioplasty. Methods: The diagnosis of CSA was made based on the history of exertional substernal chest discomfort suggestive of typical angina, physical examination, ECG changes, and 2D Echo features. Coronary angiography was performed after taking consent and PCI was performed based on the results of coronary angiography if deemed appropriate based on the existing guidelines. Patients with a SYNTAX score >22 on CAG were referred to undergo CABG. All patients were kept under follow-up and assessed for symptomatic improvement of chest pain and echocardiography along with tissue Doppler analysis was performed on day 1 and 6 weeks after PCI. Results: In this study, overall there is an insignificant improvement in transmitral E wave velocity compared to baseline value and 6 weeks after PCI with a p-value of 0.8. Trans-tricuspid E wave velocity also showed an insignificant (p=0.5) improvement 6 weeks after PCI. Trans mitral and trans-tricuspid late diastolic filling velocities also showed an insignificant improvement 6 weeks after PCI with a p-value of 0.4 and 0.6 respectively. Deceleration times of the E waves across mitral and tricuspid valves did not improve significantly after PCI. Conclusion: The study showed conventional echocardiographic parameters of mitral and tricuspid diastolic flow patterns failed to show significantly, the impact of PCI on myocardial function. Tissue Doppler parameters of myocardial systolic and diastolic function across the mitral and tricuspid valves were able to show a significant improvement in myocardial function soon after PCI and this persisted till 6 weeks after PCI. [ABSTRACT FROM AUTHOR]

Objectives: To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade. Methods: We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010–01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites. Results: Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010–2014 (52%), while non-academic sites dominated in 2015–2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46–6.85] mSv) with a 30% decline of high-dose scans (> 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%). Conclusions: Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing. Key Points: • Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease. • Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe. • Compared to academic sites, non-academic sites tend to refer more patients to downstream testing. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiovascular disease is the leading cause of mortality and morbidity worldwide, Chronic stable angina (CSA) is the main symptom of myocardial ischemia, causes increased risk of major cardiovascular events such as sudden cardiac death and myocardial infarction. Naoxintong (NXT) capsule is a classical traditional Chinese medication used to treat CSA, however, few evidence to support the wide utility of NXT capsule for the treatment of CSA. We design this study to evaluate the efficacy and safety of NXT capsule versus placebo in patients with CSA. Methods/design This is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 260 eligible participants will be enrolled. The participants will be randomized assigned in an equal ratio to groups receiving either NXT or placebo for 12 weeks. After a 2-week run-in period, they will receive either NXT or placebo (3 pills, 3 times daily) for 12 weeks. The primary outcome is therapeutic efficacy. Secondary outcome measures include the quantitative score of TCM syndromes, severity grading of angina pectoris, the number of angina pectoris per week, nitroglycerin dosage, score of Seattle angina scale, serum homocysteine, and incidence of cardiovascular events. Safety outcomes and adverse events will be monitored throughout the trial. Discussion We designed this study in accordance with principles and regulations issued by the China Food and Drug Administration (CFDA). The results will provide clinical evidence of the efficacy and safety of NXT Capsule in the treatment of CSA. Trial registration Chinese Clinical Trial Registry ChiCTR2100044563 . Registered on 24 March 2020.

Abstract Background Glucagon-like peptide-1 receptor (GLP-1R) activation may improve myocardial performance in the context of ischaemia, independent of glycaemic control, in individuals with and without type 2 diabetes mellitus. Methods The LIONESS trial was a single-centre randomised double-blind placebo-controlled crossover study to determine whether prolonged GLP-1R activation could improve exercise haemodynamics in chronic stable angina patients. Eligibility criteria comprised angiographic evidence of obstructive coronary artery disease (CAD) and an abnormal baseline exercise tolerance test (ETT) demonstrating > 0.1 mV of planar or downsloping ST-segment depression (STD). Those randomised to active agent started with a 1-week run-in phase of 0.6 mg liraglutide daily, an established injectable GLP-1R agonist, followed by 1 week of 1.2 mg liraglutide, after which patients performed a week 2 ETT. Patients then self-administered 1.8 mg liraglutide for a week before completing a week 3 ETT. The placebo arm received visually and temporally matched daily saline injections. Participants then crossed over to a 3-week course of saline injections interspersed with a week 5 ETT and week 6 ETT and vice versa. Co-primary endpoints were rate pressure product (RPP) at 0.1 mV STD and magnitude of STD at peak exercise. Results Twenty-two patients (21 without diabetes) were randomised. There was no significant difference between saline versus liraglutide in the co-primary endpoints of RPP achieved at 0.1 mV STD (saline vs. liraglutide 1.2 mg p = 0.097; saline vs. liraglutide 1.8 mg p = 0.48) or the degree of STD at peak exercise (saline vs. liraglutide 1.2 mg p = 0.68; saline vs. liraglutide 1.8 mg p = 0.57). Liraglutide did not cause symptomatic hypoglycaemia, renal dysfunction, acute pancreatitis or provoke early withdrawal from the trial. Liraglutide significantly reduced weight (baseline 88.75 ± 16.5 kg vs. after liraglutide 87.78 ± 16.9 kg; p = 0.0008) and improved the lipid profile (mean total cholesterol: at baseline 3.97 ± 0.88 vs. after liraglutide 3.56 ± 0.71 mmol/L; p

Background: 18F-NaF PET/CT identifies high-risk plaques due to active calcification in coronary arteries with potential to characterize plaques in ST-elevation myocardial infarction (MI) and chronic stable angina (CSA) patients. Methods: Twenty-four MI and 17 CSA patients were evaluated with 18F-NaF PET/CTCA for SUVmax and TBR values of culprit and non-culprit plaques in both groups (inter-group and intra-group comparison), and pre- and post-interventional MI plaques sub-analysis. Results: Culprit plaques in MI patients had significantly higher SUVmax (1.6; IQR 0.6 vs 1.3; IQR 0.3, P = 0.03) and TBR (1.4; IQR 0.6 vs 1.1; IQR 0.4, P = 0.006) than culprit plaques of CSA. Pre-interventional culprit plaques of MI group (n = 11) revealed higher SUVmax (P = 0.007) and TBR (P = 0.008) values than culprit CSA plaques. Culprit plaques showed significantly higher SUVmax (P = 0.006) and TBR (P = 0.0003) than non-culprit plaques in MI group, but without significant difference between culprit and non-culprit plaques in CSA group. With median TBR cutoff value of 1.4 in MI culprit plaques, 6/7 plaques (85.7%) among the event prone non-culprit lesions had TBR values > 1.4 in CSA group. Conclusion: The study shows higher SUVmax and TBR values in MI culprit plaques and comparable TBR values for event prone plaques of CSA group in identifying high-risk plaques. [ABSTRACT FROM AUTHOR]

Chronic stable angina pectoris, the most prevalent symptomatic manifestation of coronary artery disease, greatly impairs quality of life and is associated with an increased risk for adverse cardiovascular outcomes. Better understanding of the pathophysiologic mechanisms of myocardial ischemia permitted new therapeutic strategies to optimize the management of angina patients. Ideally, antianginal drug treatment should be tailored to individual patient's profile and chosen according to the pathophysiology, hemodynamic profile, adverse effects, potential drug interactions and comorbidities. In this respect, and because of its peculiar mechanism of action, ranolazine represents an alternative therapeutic approach in patients with chronic stable angina and may be considered the first choice in presence of comorbidities that difficult the use of traditional therapies. Advances in the diagnosis and treatment of diseases of the coronary arteries (the vessels that provide oxygen and nutrients to the heart) have greatly reduced the mortality of heart attacks and prolonged life expectancy for many years. The consequence is a growing population with chronic disease of the coronary arteries. Healthy lifestyle (regular exercise, no smoking and healthy diet), control of risk factors (in particular, high blood pressure and high cholesterol) and the use of medications to prevent future heart attacks is of paramount importance and requires the active participation of patients and their families. Angina (chest pain or discomfort caused by reduced blood flow to the heart) is the most frequent complaint of this chronic condition and requires the use of medications (antianginal drugs) that should be selected according to the patient's profile and the simultaneous presence of other diseases or medical conditions in the patient. This is call tailored therapy. Physicians should identify the best antianginal drug for each patient, and the patient should carefully follow instructions to improve quality of life, reduce medical visits and hospitalizations and improve outcomes. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) and heart failure (HF) are major worldwide threat to health and well-being. Important progress in the treatment of CAD and HF have contributed to a decline in mortality around the world. A considerable number of epidemiological studies reported a strong independent association between elevated heart rate and major cardiovascular risk factors including atherosclerosis, ventricular arrhythmias, and left ventricular dysfunction. Ivabradine (IVA) is a pure heart rate-lowering agent with well-documented anti-anginal and anti-ischemic properties comparable to well-established anti-anginal agents, such as beta-blockers and calcium channel blockers. The heart rate reduction with IVA is beneficial in patients with CAD, chronic stable angina pectoris, and chronic HF, with an acceptable tolerance and safety profile. The pharmacodynamic and pharmacokinetic properties of this drug make it an important agent in the management of patients with CAD and HF. The aim of this short review is to explore recent results with IVA, a new medication that lowers heart rate by selectively inhibiting the If current, and to describe others future potential applications.

Background: Type 2 diabetes mellitus (T2DM) leads to cardiac autonomic neuropathy (CAN), affecting blood flow and heart rate regulation eventually causing chronic stable angina (CSA). Percutaneous coronary intervention (PCI) can correct autonomic dysfunctions and improve myocardial perfusion. This study aimed to assess CAN using heart rate variability (HRV) and cardiovascular reflex tests in T2DM patients with CSA before and after PCI., Material and Methods: From cardiology outpatient clinics, 30 patients with T2DM with CSA were recruited. Before and after PCI, the following HRV parameters like low frequency (LF), high frequency (HF), LF:HF ratio, total power (TP), square root of mean square differences of successive R-R intervals (RMSSD), standard deviation of normal R-R intervals (SDNN), and percentage of adjacent NN intervals that differ from each other by more than 50 seconds (pNN50) were measured for every patient. Cardiovascular reflex tests, including the deep breathing test, the isometric handgrip test, the 30:15 ratio, the Valsalva ratio, and the lying-to-standing test (LST), were performed on the patients both before and after PCI. SPSS version 21.0 (IBM Corp., Armonk, NY), a licensed statistical program, was used to compile and analyze the data., Results: When compared to the pre-PCI group, 30 patients with T2DM with CSA, age range between 45 and 70 years, both genders demonstrated a significant increase in post-PCI HRV frequency domain parameters, such as LF (239.52±67.21ms 2 vs. 307.62±74.17 ms 2 ) and HF (249±25.21 ms 2 vs. 379.67±76.55 ms 2 ). The time domain parameters showed a significant increase in post-PCI values compared to pre-PCI values. These included RMSSD (33.97±3.96 ms vs. 8.005±3.25 ms), SDNN (41.4±9.78 vs. 31.74±7.04ms), NN50 (13.241±3.07 vs. 5.20±6.63), and TP (1130.08±320.10 ms 2 vs. 754.54±96.93 ms 2 ). In cardiovascular reflex tests, pre-PCI groups had significantly lower delta HR (DBT) (10.47±1.76 bpm vs. 14.20±2.09), E:I ratio (DBT) (1.14±0.042 vs. 1.20±0.026), and Valsalva ratio (1.10±0.071 vs. 1.22±0.084) than post-PCI groups. The pre-PCI group showed a substantial decrease in both the systolic blood pressure (LST) (-6.13±4.85 mmHg vs. -1.01±3.63 mmHg) and the 30:15 ratio (1.13±0.074 vs. 1.09±0.067) when compared to the post-PCI group. The handgrip test (18.73±4.31 mmHg vs. 15.31±4.27 mmHg) did not yield statistically significant results., Conclusions: Before PCI, T2DM patients with CSA experienced autonomic dysfunction, but after revascularization, their functions improved by reestablishing basal cardiac autonomic tone and autonomic reactivity. HRV and cardiovascular reflex tests are useful noninvasive tools for assessing CAN and stratifying a prospective risk factor for estimating the morbidity and death from cardiovascular illnesses in T2DM with CSA., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institute Ethics Committee of Vardhman Mahavir Medical College and Safdarjung Hospital issued approval IEC/VMMC/SJH/Thesis/October/2017-177. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alauddin et al.)

Ranolazine derives from piperazine and has been approved as a drug for the therapy of chronic stable angina. It acts by selectively inhibiting the late sodium inward current. Moreover, ranolazine has other metabolic features which makes it effective in other diseases as well as coronary artery ones. In this paper I make an updated review of all possible therapeutic roles of ranolazine: through cardiology and beyond. [ABSTRACT FROM AUTHOR]

Ranolazine derives from piperazine and has been approved as a drug for the therapy of chronic stable angina. It acts by selectively inhibiting the late sodium inward current. Moreover, ranolazine has other metabolic features which makes it effective in other diseases as well as coronary artery ones. In this paper I make an updated review of all possible therapeutic roles of ranolazine: through cardiology and beyond.

Objective: Evaluation of the diagnostic value of speckle tracking echocardiography (STE) at rest and during dobutamine stress in predicting the presence and severity of coronary artery disease (CAD) in patients with chronic stable angina. Methods: A total of 100 patients with chronic stable angina were evaluated using STE at rest and during dobutamine stress to detect the presence, severity, and number of affected coronary arteries. Then, the correlation with the SYNTAX score (SS) was analyzed. Results: STE at stress showed better agreement with coronary angiography (CA) than dobutamine stress echocardiography (DSE) in detecting the presence of coronary artery stenosis (Kappa = 0.819, p 22. Stress GLPSS ≥ −12.5% had the best diagnostic accuracy (sensitivity = 82.4%; specificity = 78.3%) in predicting SS > 22. Conclusion: Speckle tracking during DSE has high sensitivity and specificity for predicting the presence of CAD. It provides quantitative diagnostic information that decreases the false positive and false negative results of DSE.

Background: Cardiovascular disease is the leading cause of mortality and morbidity worldwide, Chronic stable angina (CSA) is the main symptom of myocardial ischemia, causes increased risk of major cardiovascular events such as sudden cardiac death and myocardial infarction. Naoxintong (NXT) capsule is a classical traditional Chinese medication used to treat CSA, however, few evidence to support the wide utility of NXT capsule for the treatment of CSA. We design this study to evaluate the efficacy and safety of NXT capsule versus placebo in patients with CSA.Methods/design: This is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 260 eligible participants will be enrolled. The participants will be randomized assigned in an equal ratio to groups receiving either NXT or placebo for 12 weeks. After a 2-week run-in period, they will receive either NXT or placebo (3 pills, 3 times daily) for 12 weeks. The primary outcome is therapeutic efficacy. Secondary outcome measures include the quantitative score of TCM syndromes, severity grading of angina pectoris, the number of angina pectoris per week, nitroglycerin dosage, score of Seattle angina scale, serum homocysteine, and incidence of cardiovascular events. Safety outcomes and adverse events will be monitored throughout the trial.Discussion: We designed this study in accordance with principles and regulations issued by the China Food and Drug Administration (CFDA). The results will provide clinical evidence of the efficacy and safety of NXT Capsule in the treatment of CSA.Trial Registration: Chinese Clinical Trial Registry ChiCTR2100044563 . Registered on 24 March 2020. [ABSTRACT FROM AUTHOR]

Objective: In the present study, cardiac autonomic functions in CSA patients were evaluated before and after percutaneous coronary intervention (PCI) using heart rate variability (HRV). Methods: Thirty patients with CSA were recruited from cardiology outpatient clinics of VMMC and Safdarjung hospital, New Delhi, India. For each patient HRV parameters (LF, HF, LF:HF ratio, SDNN, RMSSD, total power, and pNN50) were gathered before and after PCI. Data were compiled and analyzed using licensed statistical software: SPSS version 21.0. Results: Out of 30 subjects, SDNN (61.47±22.27 vs. 32.24±16.50ms, p<0.0001), RMSSD (53.86±31.41 vs. 28.81±23.80ms, p=0.001) and pNN50 (46.24±34.36 vs. 5.20±6.63, p<0.0001) in post-PCI were significantly higher as compared to the pre-PCI values. There were significant increases in both LF (1193ms²±302.04ms²vs. 1054.60ms²±208 ms², p<0.001) and HF (991.57±872.40ms2vs. 466.72ms²±257.93ms², p<0.0001), also in total power (3548.37ms²±807.73ms²vs. 2428 ms²±867.07 ms², p<0.0001) in post-PCI as compared to pre-PCI. The LF:HF ratio in pre-PCI was higher as compared to post-PCI (1.467±1.639 vs. 1.143±0.852, p=0.805), but the difference was not statistically significant. Conclusion: In this preliminary study, it is concluded that there is significant improvement in resting cardiovascular parameters, resting autonomic tone as measured by HRV which shows increase in both parasympathetic as well as sympathetic reactivity following revascularization by PCI in CSA patients. Hence, we also suggest that the use of noninvasive tests such as HRV should be done to stratify further risk of disease progression. [ABSTRACT FROM AUTHOR]

Background: Glucagon-like peptide-1 receptor (GLP-1R) activation may improve myocardial performance in the context of ischaemia, independent of glycaemic control, in individuals with and without type 2 diabetes mellitus. Methods: The LIONESS trial was a single-centre randomised double-blind placebo-controlled crossover study to determine whether prolonged GLP-1R activation could improve exercise haemodynamics in chronic stable angina patients. Eligibility criteria comprised angiographic evidence of obstructive coronary artery disease (CAD) and an abnormal baseline exercise tolerance test (ETT) demonstrating > 0.1 mV of planar or downsloping ST-segment depression (STD). Those randomised to active agent started with a 1-week run-in phase of 0.6 mg liraglutide daily, an established injectable GLP-1R agonist, followed by 1 week of 1.2 mg liraglutide, after which patients performed a week 2 ETT. Patients then self-administered 1.8 mg liraglutide for a week before completing a week 3 ETT. The placebo arm received visually and temporally matched daily saline injections. Participants then crossed over to a 3-week course of saline injections interspersed with a week 5 ETT and week 6 ETT and vice versa. Co-primary endpoints were rate pressure product (RPP) at 0.1 mV STD and magnitude of STD at peak exercise. Results: Twenty-two patients (21 without diabetes) were randomised. There was no significant difference between saline versus liraglutide in the co-primary endpoints of RPP achieved at 0.1 mV STD (saline vs. liraglutide 1.2 mg p = 0.097; saline vs. liraglutide 1.8 mg p = 0.48) or the degree of STD at peak exercise (saline vs. liraglutide 1.2 mg p = 0.68; saline vs. liraglutide 1.8 mg p = 0.57). Liraglutide did not cause symptomatic hypoglycaemia, renal dysfunction, acute pancreatitis or provoke early withdrawal from the trial. Liraglutide significantly reduced weight (baseline 88.75 ± 16.5 kg vs. after liraglutide 87.78 ± 16.9 kg; p = 0.0008) and improved the lipid profile (mean total cholesterol: at baseline 3.97 ± 0.88 vs. after liraglutide 3.56 ± 0.71 mmol/L; p < 0.0001). Conclusion: Liraglutide did not enhance exercise tolerance or haemodynamics compared with saline placebo during serial treadmill testing in patients with established obstructive CAD. It did, however, significantly reduce weight and improve the lipid profile. Trial Registration ClinicalTrials.gov Identifier NCT02315001. Retrospectively registered on 11th December 2014. [ABSTRACT FROM AUTHOR]

Ivabradine (IVA) is an inhibitor of the If channel, the main determinant of the pacemaker function of the sinus node. This pure heart rate-lowering agent possesses well-documented antianginal and antiischemic properties comparable to well-established antianginal agents, such as β-blockers and calcium channel blockers. IVA lowers heart rate (HR) without affecting contractility or vascular tone and it is licensed for HR control in chronic heart diseases. The heart rate reduction is beneficial in patients with coronary artery disease (CAD), chronic stable angina pectoris, and chronic heart failure (CHF). Published trials documented not only pharmacodynamic and pharmacokinetic properties but also acceptable tolerance and safety profile of IVA, compared to other currently used cardiovascular drugs, including betablockers. The aim of this review is to describe recent evidences with IVA an interesting medicament, able to lower HR by selective inhibition of the If current, and to describe its applications. [ABSTRACT FROM AUTHOR]

Objectives: To study the effect of ranolazine on improvement of left ventricular (LV) dysfunction in comparison to trimetazidine in patients with chronic stable angina (CSA). Ranolazine is an anti-anginal agent that acts on the late inward sodium current and prevents pathologic intracellular calcium accumulation that leads to ischemia, myocardial dysfunction, and electrical instability. Methodology: After screening and obtaining informed consent, 29 patients with CSA who have sustained ST-Elevation Myocardial Infarction more than 12 weeks ago with LV ejection fraction (LVEF) ≤40% in a 2:1 ratio to receive ranolazine 500 mg BD (n = 19) or trimetazidine 35 mg BD (n = 10) were enrolled in the study. The patients were evaluated at the end of 8 weeks for the improvement in LV dysfunction by transthoracic echocardiography. Results: No significant difference was found in the baseline characteristics of the patients between the two groups except the increased body mass index among users of trimetazidine (26.3 ± 5.07 vs. 22.1 ± 3.26, P = 0.03). Study patients receiving ranolazine 500 mg BD for 8 weeks significantly improved the LVEF. No improvement was seen in diastolic function. Ranolazine was well tolerated among the patients. Conclusion: Ranolazine at a dose of 500 mg BD given for 8 weeks helps in improving the LVEF in patients with CSA and is a suitable option than trimetazidine among patients with CSA.

Background: Longitudinal strain analysis has been shown to be useful in patients with acute coronary syndromes and in stress echocardiography. The objective of this study is to identify the incremental diagnostic value of longitudinal strain analysis at rest, when added to routine treadmill testing (TMT), in identifying the presence of coronary artery disease in patients presenting with chronic stable angina (CSA). Methodology: We conducted a prospective study in which adult patients presenting with CSA and normal systolic function were enrolled. All patients were examined by 2-D echocardiography, longitudinal strain analysis, TMT, and either conventional coronary angiography and/ or coronary computed tomography angiography. Results: We enrolled a total of 150 subjects (54±7.8 years, 63% male). The sensitivity and specificity of TMT was 60.2% and 65.5% respectively. In comparison, global longitudinal strain (GLS) alone had better sensitivity (72.7%) and specificity (74.2%). Post-systolic shortening (PSS) had similar sensitivity for early detection of significant CAD. The combination of TMT and GLS provided the best overall diagnostic accuracy with a sensitivity of 85.4% and specificity of 87.5%, respectively. The optimal cut off for GLS for identification of coronary artery disease was −17.75%. Conclusions: In patients presenting with chronic stable angina and normal systolic function, global longitudinal strain and post systolic shortening assessed at rest have excellent diagnostic accuracy for coronary artery disease. Longitudinal strain analysis is superior to conventional TMT and adds to its diagnostic performance.

Coronary artery fistulas may be defined as abnormal connections between a coronary artery and either a heart chamber or the pulmonary artery. Although usually asymptomatic, they can become enlarged and rupture in rare instances, requiring prompt intervention. We present a case of a 66-year-old male patient with a left anterior descending-pulmonary artery fistula managed with coil embolization., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chakraborty et al.)

Background: The inflammatory process is actively involved in atherosclerosis and underlies all stages of atherosclerotic plaque development: the beginning, the progression and the plaque rupture. It has been reported that during the inflammatory process the expression of Gal-3 is increased in human atherosclerotic lesions, suggesting its involvement in atherogenesis. Aim: In the present study, we tried to evaluate the levels of Gal-3 in patients with chronic stable angina and its relation to the severity of coronary artery disease (CAD) and the CAD risk factors such as Aging, Diabetes, Hypertension, Smoking and Dyslipidemia. Patients and Methods: Our study population consisted of 95 chronic stable angina patients who were planned for coronary angiography. All patients had clinical and/or electrocardiographic evidence of significant stable ischemic heart disease. Results: We found a significant positive correlation between CAD and Gal-3 levels (r = 0.207), (p value= 0.045). Patients with multi-vessel (MVD) had significantly higher plasma Gal-3 levels and syntax score than 3 vessel disease (TVD) and single vessel disease (SVD) (P value <0.001)., while Patients with TVD had significantly higher plasma Gal-3 levels and syntax score than SVD, but still lower than MVD Patients (P value <0.001. Conclusion: Gal-3 plasma levels were significantly correlated with the severity of CAD in chronic stable angina and can be used as a prognostic marker of chronic stable angina patients. Recommendation: We recommend that the Gal-3 might be useful for risk stratification and outcome prediction of coronary heart diseases. [ABSTRACT FROM AUTHOR]

Background Indeed, previous studies have been reported that mildly elevated bilirubin levels in Gilbert's syndrome are associated with lower ischemic heart disease risk compared with general population. 1 Also, a recent study revealed by Gul et al. that total bilirubin levels independently predict adverse cardiac events in ST-segment elevation myocardial infarction (STEMI) patients who undergo primary percutaneous coronary intervention (PCI), 2 the present study focused on studying the role of bilirubin and its relationship with the severity of CAD. Patents and methods We included 102 consecutive patients presented with chronic stable angina were referred for elective coronary angiography in our Cath. Lab. Then complete history was taken, general and local examination was done, blood sample was taken for laboratory tests with special attention to serum total bilirubin, indirect bilirubin and direct bilirubin, resting 12 lead ECG (evidence of ischemia) and bedside screening ECHO (EF, LV dimensions and WMA) was done on admission. Lastly, coronary angiography was performed after obtaining informed consent coronary angiograms, GENSINI score and SYNTAX score were examined by two experienced interventional cardiologists who were blinded to the clinical characteristics and laboratory results of the patients. Results The serum total bilirubin has a cutoff value for prediction of severe CAD = 0.595 mg/dl with a sensitivity 86% and specificity 84%. The serum indirect bilirubin level has a cutoff value for prediction of severe CAD = 0.395 mg/dl with a sensitivity 76% and specificity 85%. Combination of TB and IB cutoff values for prediction of the severe coronary artery disease will raise the specificity of the tests from 84% and 85% respectively to 87%. Conclusion Serum total and indirect bilirubin have a role for prediction of severe CAD in patients with chronic stable angina. [ABSTRACT FROM AUTHOR]

Background Cardiovascular disease is one of the major causes of mortality from non-communicable diseases. In recent years there has been a growing interest in herbal medicine as a complementary therapy for the treatment of multiple conditions. The aim of this study was to determine the effects of Melissa officinalis (MO) on the results of echocardiography, exercise stress test, cardiovascular serum biomarkers such as lactate dehydrogenase (LDH) and nitric oxide (NO), and blood pressure in patients with chronic stable angina (CSA). Materials & methods Eighty patients with CSA were randomly divided into case and control groups in a double-blind clinical trial. They received 3 g/d lemon balm or placebo for 2 months. Anthropometric measurements, echocardiography and exercise stress test were performed before and after intervention. Also, LDH and NO were measured as cardiovascular parameters. Results The mean levels of Ejection Fraction (EF) in the echocardiographyand maximum workload in the exercise test were significantly higher in the intervention group compared with placebo (p < 0.01) post intervention. Moreover, the mean serum level of LDH was significantly (p < 0.001) lower in the intervention group compared with control group. Additionally, the mean serum level of NO was higher in the intervention group compared with placebo (p < 0.01) post intervention. Systolic and diastolic blood pressure (SBP, DBP) were also decreased in the intervention group compared with placebo (p < 0.05) post intervention. Conclusion The results show that MO supplementation may improve EF,maximum workload, cardiovascular serum biomarkers (LDH, NO), and blood pressure in patients with CSA. [ABSTRACT FROM AUTHOR]