Changing scenario in chronic ischemic heart disease: Therapeutic implications
Changing scenario in chronic ischemic heart disease: Therapeutic implications
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DOI：
10.1016/j.amjcard.2006.07.002
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发表时间：
2006-09-04
影响因子：
2.8
通讯作者：
Focardi, Marta
中科院分区：
文献类型：
--
作者：
Marzilli, Mario;Affinito, Silvia;Focardi, Marta
在过去的30年里，慢性缺血性心脏病（IHD）的药物治疗取得了相当大的进展。大多数药物治疗通过减少心肌耗氧量、增加冠状动脉血流量、改善心室舒张、扩张侧支血管和降低外周阻力起作用。尽管“最佳”的药物治疗，大部分患者继续存在心绞痛和心肌缺血。冠状动脉成形术（经皮腔内冠状动脉成形术）可能会改善症状，但包括老年人或糖尿病或心力衰竭患者在内的几个亚组的患者代表了不总是从冠状动脉血运重建中获益的高危人群。流行病学研究表明，与前几十年相比，预期寿命更长，糖尿病的流行率在世界范围内急剧增加。此外，由于急性心肌梗死的死亡率降低和接受冠状动脉血运重建的患者的生存率提高，心力衰竭的患病率正在增加。我们专注于这种变化的情况下，慢性缺血性心脏病，并提出了一种创新的方法来治疗心绞痛在这种情况下。(c)2006年爱思唯尔公司All rights reserved.
Over the last 30 years, considerable progress has been made in drug therapy for chronic ischemic heart disease (IHD). Most pharmacologic therapies act by reducing myocardial oxygen consumption, increasing coronary blood flow, improving ventricular relaxation, dilating collateral vessels, and reducing peripheral resistances. Despite "optimal" medical therapy, a large fraction of patients continue to present with angina and myocardial ischemia. Coronary angioplasty (percutaneous transluminal coronary angioplasty) may improve symptoms, but several subgroups of patients, including the elderly, or those who have diabetes mellitus or heart failure, represent high-risk populations that do not always benefit from coronary revascularization. Epidemiologic studies show that life expectancy is longer compared with previous decades and that the prevalence of diabetes is increasing sharply worldwide. In addition, the prevalence of heart failure is growing because of the decreased death rate from acute myocardial infarction and improved survival of patients who have undergone coronary revascularization. We focus on this changing scenario of chronic IHD and propose an innovative approach to the treatment of angina in this context. (c) 2006 Elsevier Inc. All rights reserved.