The effect of repaglinide on ischemic preconditioning / Efeito da repaglinida sobre o pré-condicionamento isquêmico

AUTOR(ES)

Roberto Tadeu Barcellos Betti

DATA DE PUBLICAÇÃO

2007

RESUMO

Background: The increase of tolerance to myocardial ischemia observed during the second of two sequential exercise tests, the warm-up phenomenon, has been proposed as a clinical model of ischemic preconditioning. Blockers of K-ATP channels, such as the Sulfonylurea drugs, can induce loss of ischemic preconditioning, what could be involved in an increase of cardiac events. Repaglinide is a hypoglycemic agent with supposedly lower influence on ischemic preconditioning, despite acting in K-ATP channels. Objectives and Methods: This study investigated the effects of repaglinide on the ischemic preconditioning in diabetic patients with CAD. There were 42 patients and inclusion criteria were positive treadmill test for myocardial ischemia. Sulphonylureas and beta-blocking agents were withdrawn 30 and 7 days respectively before phase 1 of the study. In this phase, the patients underwent two consecutive treadmill exercise tests at 30 minute intervals (test 1 and test 2). In phase 2 of the study, all patients received repaglinide 2 mg three times daily during 7 days before treadmill exercise test (test 3 and test 4). Results: All patients achieved 1.0 mm ST-segment depression during phase 1. The time achieved to ST depression during test 2 was greater than that during test 1 (4:44s vs. 5:37s. p=0.001) as well as the duration of the exercise (6:15s vs.6: 29s. p=0.008), suggesting a higher ischemic threshold. In phase 2 after repaglinide, all patients achieved 1 mm ST-segment depression. However, the time achieved to ST depression, as well as the duration of the exercise, was lower in test 4 comparing with test 3. There were no statistical differences regarding angina episodes in phase 1 or phase 2. Conclusions: In diabetic patients with stable coronary disease, the oral hypoglycemic agent repaglinide abolished the myocardial ischemic preconditioning.

ASSUNTO(S)

diabetes mellitus myocardial ischemia pré-condicionamento isquêmico myocardial ischemic preconditioning. isquemia miocárdica diabetes mellitus

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