1
|
Petrovic MT, Djordjevic-Dikic A, Giga V, Boskovic N, Vukcevic V, Cvetic V, Mladenovic A, Radmili O, Markovic Z, Dobric M, Aleksandric S, Tesic M, Juricic S, Nedeljkovic Beleslin B, Stojkovic S, Ostojic MC, Beleslin B, Picano E. The Coronary ARteriogenesis with combined Heparin and EXercise therapy in chronic refractory Angina (CARHEXA) trial: A double-blind, randomized, placebo-controlled stress echocardiographic study. Eur J Prev Cardiol 2020; 28:1452-1459. [PMID: 33611455 DOI: 10.1177/2047487320915661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronary collateral circulation exerts protective effects on myocardial ischaemia due to coronary artery disease and can be promoted by exercise with heparin co-administration. Whether this arteriogenetic effect is accompanied by functional improvement of left ventricle during stress and lessening of angina symptoms remains unknown. AIMS To evaluate the anti-ischaemic efficacy of heparin plus exercise in coronary artery disease. METHODS In a prospective, single-centre, randomized, double-blind study we recruited 32 'no-option' patients (27 males; mean age 61 ± 8 years) with stable angina, exercise-induced ischaemia and coronary artery disease not suitable for revascularization. All underwent a two-week cycle of exercise (two exercise sessions per day, five days per week) and were randomized (n = 16 per group) to intravenous placebo (0.9% saline) versus unfractionated heparin (5.000 IU intravenously), 10 min prior to exercise. We assessed Canadian Cardiovascular Society angina class, stress electrocardiogram and echo parameters (wall motion score index) and computed tomography angiography for collaterals. RESULTS After two-week cycle, Canadian Cardiovascular Society class statistically decreased in both groups (heparin plus exercise group: 2.6 ± 0.7 to 1.9 ± 0.7, p < 0.001, exercise group: 2.4 ± 0.7 to 2.1 ± 0.9, p = 0.046). Only the heparin plus exercise group improved time-to-ST segment depression (before 270, 228-327 s vs. after 339, 280-360 s, p = 0.012) and wall motion score index (before 1.38 ± 0.25 vs. after 1.28 ± 0.18, p = 0.005). By multi-slice computed tomography angiography, collaterals improved in 12/15 (80%) in the heparin plus exercise group versus 2/16 (12.5%) in the exercise group (p < 0.001). CONCLUSION A two-week, 10-test cycle of heparin plus exercise is better than exercise in improving angina class, myocardial ischaemia and collaterals by computed tomography angiography.
Collapse
Affiliation(s)
- Marija T Petrovic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Vojislav Giga
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Vladan Vukcevic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Vladimir Cvetic
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Ana Mladenovic
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Oliver Radmili
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Zeljko Markovic
- Radiology Department, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Milan Dobric
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Srdjan Aleksandric
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Stefan Juricic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Biljana Nedeljkovic Beleslin
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Sinisa Stojkovic
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | | | - Branko Beleslin
- Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Eugenio Picano
- Institute of Clinical Physiology, CNR - Consiglio Nazionale Ricerche, Italy
| |
Collapse
|