Safety and efficacy of ranolazine in hypertrophic cardiomyopathy: Real-world experience in a National Referral Center.

Alessia Tomberli, Iacopo Olivotto, Niccolò Maurizi, Martina Gabriele, Luigi Tassetti, Chiara Zocchi, Silvia Passantino, Francesco Cappelli, Katia Baldini, Raffaele Coppini, Alberto Marchi, Lorenzo-Lupo Dei, Mattia Zampieri, Alessia Argirò, Silvia Favilli, Niccolò Marchionni, Cecilia Ferrantini

Journal: International journal of cardiology 2022;370():271-278

PMID: 36228766

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Abstract

OBJECTIVES

We assessed the efficacy and safety of ranolazine in real-world patients with hypertrophic cardiomyopathy (HCM).

BACKGROUND

Ranolazine is an anti-anginal drug that inhibits the late phase of the inward sodium current. In a small prospective trial, ranolazine reduced the arrhythmic burden and improved biomarker profile in HCM patients. However, systematic reports reflecting real-world use in this setting are lacking.

METHODS

Changes in clinical and instrumental features, symptoms and arrhythmic burden were evaluated in 119 patients with HCM before and during treatment with ranolazine at a national referral centre for HCM.

RESULTS

Patients were treated with ranolazine for 2 [1-4] years; 83 (70%) achieved a dosage ≥1000 mg per day. Treatment interruption was necessary in 24 patients (20%) due to side effects (n = 10, 8%) or disopyramide initiation (n = 8, 7%). Seventy patients (59%) were treated with ranolazine for relief of angina. Among them, 51 (73%) had total symptomatic relief and 47 patients (67%) showed ≥2 Canadian Cardiovascular society (CCS) angina grade improvement. Sixteen patients (13%) were treated for recurrent ventricular arrhythmias, including 4 with a clear ischemic trigger, who experienced no further arrhythmic episodes while on ranolazine. Finally, 33 patients (28%) were treated for heart failure associated with severe diastolic dysfunction: no symptomatic benefit could be observed in this group.

CONCLUSION

Ranolazine was safe and well tolerated in patients with HCM. The use of ranolazine may be considered in patients with HCM and microvascular angina.

Address: Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.; Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy. Electronic address: [email protected].; Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy; Cardiology, Health and Environmental Science|, University of L'Aquila, L'Aquila, Italy.; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; O.U. of Cardiology, A.O.U. Meyer, Florence, Italy.; Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy; Service of Cardiology, University Hospital of Lausanne, Switzerland.; Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.; Department NeuroFarBa, University of Florence, Florence, Italy.

DOI: 10.1016/j.ijcard.2022.10.014

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MeSH Terms: Humans, Ranolazine, Prospective Studies, Canada, Cardiomyopathy, Hypertrophic, Angina Pectoris, Treatment Outcome, Acetanilides