| BackgroundCoronary microvascular dysfunction(CMD)can be classified into the following four types:One is in the absence of obstructive coronary artery disease and myocardial disease,the main manifestation is microvascular angina(MVA);The other is accompanied by cardiomyopathy,including hypertrophic cardiomyopathy,dilated cardiomyopathy,myocardial amyloidosis,myocarditis,aortic valve stenosis,Anderson syndrome,etc;The third is accompanied by obstructive coronary artery disease,including stable angina,acute coronary syndrome;Fourth,iatrogenic coronary artery injury,including percutaneous coronary intervention,coronary artery bypass grafting.Angina pectoris is the main clinical manifestation of ischemic heart disease,which is caused by the imbalance of oxygen supply and oxygen demand in the heart,resulting in the accumulation of metabolites which can lead to pain.Angina pectoris has a great impact on the health and quality of life of the patients.Ranolazine,as a derivative of piperazine,is mainly through inhibition of late inward sodium current(INa),)in cardiac repolarization and through inhibiting calcium overload plays a pharmacological role in MVA.At present,the main mechanism of ranolazine against myocardial ischemia confirmed by the present study is the regulation of ion channels,which makes the ischemic cardiomyocytes maintain ion homeostasis to improve myocardial ischemia and improve angina pectoris symptom and cardiac function.At present,ranolazine has been approved as a second-line treatment for stable angina,but its efficacy of ranolazine in the treatment of MVA is still controversial.ObjectiveIn order to clarify the therapeutic effect of ranolizine in patients with MVA,thepublished high quality literatures are collected and analyzed which can provide morevaluable evidence for clinical drug treatment of MVA patients.MethodsWe searched the Cochrane Clinical Trails Register Database,MEDLINE,Embase,web of science,China knowledge Web,Wanfang and other databases from the initial database to October 2018.Key words including:ranolazine,coronary microvascular dysfunction(CMD),coronary microcirculatory disorder,microvascular angina(MVA).We imported all the retrieved documents into the Endnote software,and filtered out the documents according to the inclusion and exclusion criteria.According to the quality assessment of randomized controlled trial(RCT)prescribed by Cochrane manual,the quality of the literatures was evaluated,and the final selected documents were determined,and then,the full texts of articles were obtained.We extracted the required data and related data from the texts which could be used to final analysis.The meta analysis was performed with Revman 5.0.The main outcome index was Seattle angina questionnaire(SAQ),and the secondary outcome index:myocardial perfusion reserve index(MPRI),coronary artery flow reserve(CFR),the ventricular peak filling rate(PFR).These outcomes were used to evaluate the effectiveness of ranolazine treatment in a comprehensive way.I2test was used for statistical heterogeneity analysis.And finally we explored the impact of each experiment on the overall results by sensitivity analysis.ResultsA total of 117 related articles were obtained through various searching.After screening,7 articles were selected for quantitative analysis,all of which were published in English,and were RCTs.The intervention measures were ranolazine therapy or conventional drug therapy plus ranolazine,compared with placebo or conventional drug therapy but no ranolazine treatment.The results of meta-analysis showed that compared with the control group,1.SAQ:?Ranolazine could improve the degree of physical activity restriction(WMD= 5.38,95%CI=1.15-9.60,P-=O.01).?Ranolazine could increase the stable state of angina pectoris(WMD= 17.03,95%CI=7.46-26.60,P=0.0005).(3)Ranolazine could decrease the frequency of angina pectoris(WMD=10.42,95%CI=2.64?18.20,P=0.009).?Ranolazine could Improve awareness of disease(WMD=9.47,95%CI=3.94?15.05,P=0.0008).?But in the satisfactory degree of treatment,ranolazine was worse than the control group(WMD=-3.86,95%CI=-6.12?-1.60,P=0.0008).2.At the same time,the myocardial perfusion reserve index could be increased by ranolazine(WMD= 0.17,95%CI=0.09?0.24,P<0.00001).3.Ranolazine could Increase the coronary flow reserve(WMD= 0.47,95%CI=0.31-0.64,P<0.00001).4.There was no significant difference in the maximum ventricular filling rate(WMD=0.04,95%CI=0.18?0.26,P=0.74).ConclusionsCompared with the control group,ranolazine can significantly improve the symptoms and quality of life in MVA patients,and improve the cardiac reserve function.It can provide a new and effective choice for clinical drug treatment of patients with MVA. |
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