Ranolazine in Symptomatic Diabetic Patients Without Obstructive Coronary Artery Disease: Impact on Microvascular and Diastolic Function

Background: Treatments for patients with myocardial ischemia in the absence of angiographic obstructive coronary artery disease are limited. In these patients, particularly those with diabetes mellitus, diffuse coronary atherosclerosis and microvascular dysfunction is a common phenotype and may be accompanied by diastolic dysfunction. Our primary aim was to determine whether ranolazine would quantitatively improve exercise‐stimulated myocardial blood flow and cardiac function in symptomatic diabetic patients without obstructive coronary artery disease. Methods and Results: We conducted a double‐blinded crossover trial with 1:1 random allocation to the order of ranolazine and placebo. At baseline and after each 4‐week treatment arm, left ventricular myocardial blood flow and coronary flow reserve (CFR; primary end point) were measured at rest and after supine bicycle exercise using 13N‐ammonia myocardial perfusion positron emission tomography. Resting echocardiography was also performed. Multilevel mixed‐effects linear regression was used to determine treatment effects. Thirty‐five patients met criteria for inclusion. Ranolazine did not significantly alter rest or postexercise left ventricular myocardial blood flow or CFR. However, patients with lower baseline CFR were more likely to experience improvement in CFR with ranolazine (r=−0.401, P=0.02) than with placebo (r=−0.188, P=0.28). In addition, ranolazine was associated with an improvement in E/septal e′ (P=0.001) and E/lateral e′ (P=0.01). Conclusions: In symptomatic diabetic patients without obstructive coronary artery disease, ranolazine did not change exercise‐stimulated myocardial blood flow or CFR but did modestly improve diastolic function. Patients with more severe baseline impairment in CFR may derive more benefit from ranolazine. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01754259

Effect of maturation on physico-chemical and sensory quality characteristics of custard apple wine

Recently, researchers have taken a shift to utilize the custard apple for wine preparation besides its major use in ice cream, confectionary and milk products. In the present study, an attempt has been made to study the effect of maturation on physico-chemical and sensory quality characteristics of custard apple wine. Custard apple wine was prepared as per the earlier standardized method. The wine so prepared was matured for six months. The physico-chemical analysis was conducted at every three months interval for six months and sensory evaluation was performed after six months of storage. With the maturation, a decrease in total soluble solids, total sugars, titratable acidity, ethanol, total phenols and tannins was observed, whereas, an increase in reducing sugars and pH was observed. All the sensory quality characteristics of custard apple wine increased with advancement of the maturation period except astringency. Cluster analysis of the data obtained from physico-chemical analysis revealed that there was no difference between three months and six months of storage. Physico-chemical characteristics of custard apple wine were reduced to two principal components using principal component analysis which accounted for 100% variation. In general, maturation for six months improved the quality of custard apple wine considerably