Abstract 3362: Effects of Ranolazine as Monotherapy and Combination Therapy on Rate Pressure Product at Rest and During Exercise: Results from the MARISA and CARISA trials
Background: Most antianginals reduce myocardial O2 demand and thereby myocardial work. The effect of Ranolazine (Ran), a recently approved antianginal drug, on rate pressure product (RPP), an index of myocardial work, has not been reported.
Methods: We investigated the effects of Ran on rest and exercise RPP of pts in the MARISA (Ran 1000 mg BID monotherapy, n=191) and CARISA trials (Ran 1000 mg BID combination with either amlodipine [5 mg QD], diltiazem [180 mg QD], or atenolol [50 mg QD], n=823). Modified Bruce protocol was used and RPP was determined at rest, at end of each stage, at 1 mm ST depression, and at max exercise.
Results: The RPP at rest and max exercise was minimally reduced with Ran compared to placebo. Small reductions in HR and BP (2–3 bpm and/or mm Hg) at rest and max exercise were statistically significant only with Ran monotherapy at maximal exercise (table⇓). Small, statistically significant differences were observed in RPP during exercise (figure⇓) in CARISA. At 1 mm ST depression there were no significant differences in RPP with combination therapy, despite longer exercise duration to ischemia on Ran therapy.
Conclusion: Ran improves exercise performance in pts with stable angina without clinically meaningful changes in RPP as monotherapy or in combination therapy. The anti-ischemic effects of Ran do not appear to be dependent on hemodynamic changes or indices of myocardial work.