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Current Pharmaceutical Design

Eiditor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Modulation of Cardiac Metabolism During Myocardial Ischemia

Author(s): Antonio C.P. Chagas, Paulo M.M. Dourado and Tatiana de Fatima Goncalves Galvao

Volume 14 , Issue 25 , 2008

Page: [2563 - 2571] Pages: 9

DOI: 10.2174/138161208786071236

Price: $58

Abstract

Metabolic modulation during myocardial ischemia is possible by the use of specific drugs, which may induce a shift from free fatty acid towards predominantly glucose utilization by the myocardium to increase ATP generation per unit oxygen consumption. Three agents (trimetazidine, ranolazine, and perhexiline) have well-documented anti-ischaemic effects. However, perhexiline, the most potent agent currently available, requires plasma-level monitoring to avoid hepatoneuro- toxicity. Besides, the long-term safety of trimetazidine and ranolazine has yet to be established. In addition to their effect in ischemia, the potential use of these drugs in chronic heart failure is gaining recognition as clinical and experimental data are showing the improvement of myocardial function following treatment with several of them, even in the absence of ischemia. Future applications for this line of treatment is promising and deserves additional research. In particular, large, randomised, controlled trials investigating the effects of these agents on mortality and hospitalization rates due to coronary artery disease are needed.

Keywords: Metabolic modulation, cardiac ischemia, myocardial infarct, reperfusion, ischemic preconditioning


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