Metabolic therapy for heart disease: impact of trimetazidine.
Metabolic therapy for heart disease: impact of trimetazidine.
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心脏病的代谢治疗：曲美他嗪的影响。
DOI：
10.1007/s10741-005-7541-5
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发表时间：
2005
影响因子：
4.6
通讯作者：
Stanley,WilliamC
中科院分区：
文献类型：
--
作者：
Sabbah,HaniN;Stanley,WilliamC
冠状动脉疾病仍然是导致心力衰竭的主要原因。尽管针对预防性治疗和生活方式的改变做出了巨大努力，但冠状动脉疾病的发病率仍然很高，几乎没有或没有减少的迹象，并且仍然是发达国家和全世界的主要卫生经济负担。毫无疑问，溶栓治疗和直接冠状动脉成形术的积极使用对限制急性心肌梗死的后遗症产生了重大影响。通过冠状动脉旁路手术或冠状动脉血管成形术并伴随冠状动脉支架置入的常规冠状动脉血运重建对限制冠状动脉疾病症状产生了积极影响，尽管是短暂的。尽管所有这些成功的二十世纪，然而，慢性稳定型心绞痛仍然是一个主要的临床问题，必须处理的心脏病学家，内科医生和初级保健医生一样，因为我们进入下一个千年。许多稳定型心绞痛患者不适合进一步的血运重建，或者在这个定量医疗的时代，即使符合条件，也必须“排队”进行手术。不用说，大多数（如果不是全部的话）这些患者都是发展为充血性心力衰竭（CHF）的候选者，真正的下一个千年的疾病。心肌依赖于氧气来支持通过氧化磷酸化产生高能磷酸盐。后者是唯一的代谢过程，可以产生足够的化学能，以燃料的心脏收缩机制的持续需求。因此，当输送到心肌的氧的量不足以满足线粒体呼吸的要求时，高氧代谢产物的产生会降低。
Coronary artery disease remains the major contributor to the development of heart failure. Despite the massive efforts targeted toward preventative therapy and life style changes, the incidence of coronary artery disease continues to be high, shows little or no signs of abatement, and remains the leading health economic burden in developed countries and, for that matter, worldwide. There is no doubt that the aggressive use of thrombolytic therapy and primary coronary angioplasty has had a major impact on limiting the sequelae of acute myocardial infarction. There is also little doubt that routine coronary revascularization through coronary artery bypass surgery or coronary angioplasty with attendant coronary stent deployment has had a positive impact, albeit transient, on limiting symptoms of coronary artery disease. Despite all of these successes of the twentieth century, however, chronic stable angina pectoris remains a major clinical problem that must be dealt with by cardiologists, internists and primary care physicians alike as we move into the next millenium. Many of the patients that present with stable angina pectoris are not candidates for further revascularization, or, in this the age of rationed health care, even if eligible, must “stand in line” to have the procedure performed. Needless to say that most, if not all, of these patients are candidates for the development of congestive heart failure (CHF), truly the disease of the next millenium.The myocardium depends on oxygen to support high energy phosphate production by oxidative phosphorylation. The latter is the only metabolic process that can generate sufficient chemical energy to fuel the continuous needs of the contractile machinery of the heart. Accordingly, when the amount of oxygen delivered to the myocardium is insufficient to meet the requirements for mitochondrial respiration, the production of high