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May 22, 2020MedicineOpen Access

The effect of Shexiang Tongxin Dropping Pills on coronary microvascular dysfunction (CMVD) among those with a mental disorder and non-obstructive coronary artery disease based on stress cardiac magnetic resonance images

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Why the study?

Coronary microvascular dysfunction is prevalent and linked to adverse cardiac events in patients with mental disorders, but the clinical efficacy of Shexiang Tongxin Dropping Pills in these patients is unproven.

Does Shexiang Tongxin Dropping Pills improve coronary microvascular dysfunction in depressed or anxious patients with non-obstructive coronary artery disease?

Comparison

STDP combined with routine medicine vs Nicorandil combined with routine medicine

Design

Randomized trial

Follow-up

12-month

Authors

JTJinfan TianLZLijun ZhangXYXueyao Yang

Discussion

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Member takes

Overview

Should not yet change practice for CMD in this population; leaves open whether STDP improves microvascular function in anxious or depressed NOCAD.

Structured PICO

Does Shexiang Tongxin Dropping Pills improve coronary microvascular dysfunction in depressed or anxious patients with non-obstructive coronary artery disease?

P
Population
72 depressed or anxious patients (GAD-7 ≥5 and/or PHQ9 ≥5) diagnosed with non-obstructive coronary artery disease (NOCAD) combined with coronary microvascular dysfunction (CMVD) utilizing coronary artery angiography and stress cardiac magnetic resonance (CMR).
I
Intervention
Shexiang Tongxin Dropping Pills (STDP) combined with optimal medicine treatment (aspirin, statin, nitrates, b-blockers, ACEi/ARB, CCB) for 12 months.
C
Comparator
Nicorandil combined with optimal medicine treatment for 12 months.
O
Outcome
Coronary microvascular index (MBF, MPR, and MPRI) changes determined by CMR at 3 months after medication.surrogate

This study protocol describes a randomized trial to evaluate whether Shexiang Tongxin Dropping Pills improve coronary microvascular dysfunction in patients with non-obstructive coronary artery disease and comorbid anxiety or depression.

Limitations

  • CMVD could be affected by other factors such as other new-onset disease and motions during follow-up
  • 1-year of follow-up may be too short to observe the difference of MACE
  • endothelial protection function could be derived from the mental disorder improvement
  • mental disorder improvement or endothelial protection maybe not fully explain all the effectiveness of STDP on CMVD

Cite This Study

Tian et al. (2020) studied this question.

synapsesocial.com/papers/6a7f72cf024876978df6d9d4https://doi.org/10.1097/md.0000000000020099
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of nicorandil on QT dispersion in patients with stable angina pectoris undergoing elective angioplasty: A triple-blind, randomized, placebo-controlled study2017 · 9 citations
  2. 2Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation2019 · 401 citations
  3. 3Effects of Sex on Coronary Microvascular Dysfunction and Cardiac Outcomes2014 · 622 citations
  4. 4Quantitative cardiovascular magnetic resonance perfusion imaging identifies reduced flow reserve in microvascular coronary artery disease2018 · 96 citations
  5. 5Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options2018 · 774 citations