Effects Of Trimetazidine On Cardiac Autonomic Nerve Function In Patients With Coronary Intervention

Objective: Coronary atherosclerotic heart disease(CHD)is the most common cardiovascular disease,which has the characteristics of high morbidity and high mortality.In recent years,with the development of Percutaneous Coronary Intervention(PCI),the mortality of CHD has decreased.Heart rate variability(HRV)is a simple,non-invasive and reliable index for evaluating cardiac autonomic nerve function in the clinic.Studies have shown that myocardial ischemia and hypoxia in CHD patients can cause autonomic nervous system imbalance and HRV abnormalities.Trimetazidine(TMZ)is an anti-angina pectoris drug,which can regulate the energy metabolism of cardiac muscle cells and improve cardiac function.Trimetazidine has been reported to improve autonomic nerve dysfunction in patients with chronic heart failure or multiple cardiomyopathy,but little research has been done on the effect of autonomic nerve function in patients with coronary heart disease after PCI.This study investigated the effects of trimetazidine on autonomic nerves in patients with PCI by observing changes in HRV before and after PCI,and after 4 weeks of trimetazidine treatment in patients with CHD.Methods: A total of 156 patients with elective coronary angiogram for CHD who were treated in the Second Department of Cardiology of the Second Hospital of Hebei Medical University from September 2017 to September 2019 were selected.According to the inclusion and exclusion criteria,100 patients with single or dual lesions who successfully underwent vascular PCI were included in this study,and their clinical and imaging data were recorded.All patients were measured for heart rate variability within 48 hours of admission and within 48 hours after PCI.Then using randomized controlled trials,100 patients were randomly divided into two groups: the study group and the control group.The control group was given conventional treatment of CHD,including antiplatelet,aggregation,anticoagulation,statins,angiotensin-converting enzyme inhibitors(ACEI),?-blockers,nitrates and other drugs.In the study group,trimetazidine was added 20 mg per time on the basis of conventional treatment,3 times one day for 4 weeks.Heart rate variability analysis in time domain and frequency domain analysis was performed in all patients within before(48 hours after PCI)and after treatment to evaluate cardiac autonomic nerve function.Results: In 100 patients,68 were males and 32 were females,with an average age of 59.67�8.85 years(39?78 years),including 64 patients with hypertension,31 with diabetes,44 with hyperlipidemia.During PCI treatment,48 cases were anterior descending branch,17 cases were circumflex branch and 35 cases were right coronary artery.There were no significant differences in the general information and the distribution of diseased vessels between the study group and the control group(P>0.05).Before PCI,the HRV results of HR,SDNN,RMSSD,SDSD,pNN50,LF,HF,LF/HF were 67.70�7.32,39.56�14.80,19.45�9.82,18.97�9.35,2.65�1.78,65.51�16.53,27.28�15.31,3.54�2.76,with the results of after PCI were 68.21�7.54,38.58�16.19,18.70�8.70,18.45�8.47,2.54�1.67,66.59�16.60,26.12�13.88,3.61�2.54 respectively.There were no significant differences in all indicators of HRV before and after PCI(P>0.05).100 patients were divided into two groups after PCI.In the study group,the results of HRV were 68.48�7.53,38.06�15.94,19.44�9.81,19.15�9.50,2.66�1.89,64.57�17.08,28.25�14.70 and 3.35�2.51.In the control group,the above indicators were 67.94�7.61,39.09�16.58,17.95�7.43,17.76�7.32,2.43�1.42,68.61�16.02,23.99�12.81,3.88�2.56.There was no statistical difference in the comparison between the two groups(P>0.05).After 4 weeks of trimetazidine treatment,the results of HR,SDNN,RMSSD,SDSD,pNN50,LF,HF and LF/HF were 65.66�6.62,42.34�15.27,23.06�12.47,22.77�12.11,3.44�1.87,56.86�18.03,34.82�16.69,and 2.37�1.87.There were significant differences in all time and frequency domain indicators between before and after four weeks' treatment in study group(P<0.05).The results of HRV indicators in control group were 66.02�5.75,40.56�14.68,18.67�6.69,18.52�6.68,2.59�1.29,68.07�14.24,26.84�13.31,3.52�2.42 respectively.There were significant differences in HR,HF and LF/HF(P<0.05),with no significant difference in other indicators of HRV(P>0.05).Comparison results between study group and control group showed that there were significant differences in RMSSD,SDSD,pNN50,LF,HF and LF/HF(P<0.05),but no significant differences in HR,SDNN(P>0.05).Conclusion: There was no significant change in HRV indicators in patients with coronary heart disease with simple lesions treated with PCI in the short term.Standardized and conventional treatment of coronary heart disease can partially change the cardiac autonomic function.Conventional treatment with trimetazidine can significantly improve the cardiac autonomic function of patients,and the effect is better than conventional treatment.