The prevalence of heart failure with preserved ejection fraction (HFpEF) accounts for more than 50% of patients with heart failure (HF) and tends to increase with a prognosis as bad as that of HF with reduced ejection fraction (HFrEF) (1-6). Till date, no therapy has been demonstrated to improve mortality in patients with HFpEF including several large prospective, randomized controlled trial such as angiotensin converting enzyme inhibitor (ACE-I) perindopril (PEP-CHF) (7), angiotensin II receptor blockers (ARBs) candesartan (CHARM-Preserved) (8) and irbesartan (I-PRESERVE) (9), aldosterone receptor blockers spironolactone (TOPCAT (10) and Aldo-DHF (11)), and beta blocker (SENIORS) (12). Recent studies have shown that bioenergetic deficiency is involved in the pathophysiology of HFpEF and that these changes lead to myocardial remodeling and dysfunction (13). Patients with HFpEF show abnormalities in myocardial energetics in the formation of adenosine triphosphate (ATP) and movement between phosphocreatine and ATP through creatine kinase reactions. Phan et al. (14,15) found a significant reduction in the phosphocreatine/ATP ratio of patients with HFpEF compared to that in controls. Summary Heart failure with preserved ejection fraction (HFpEF) is a leading cause of morbidity and mortality without an established treatment. Diastolic dysfunction, the hallmark of HFpEF, is associated with altered myocardial bioenergetics. No previous study has examined the effects of coenzyme Q10 (CoQ10) on left ventricle (LV) diastolic function in patients with HFpEF. We investigated whether CoQ10 could improve LV diastolic function in patients with HFpEF. We performed a randomized controlled trial (RCT) using pretest and posttest control groups of 30 patients with HFpEF. The patients received either CoQ10 100 mg three times a day or no CoQ10 in addition to routine treatment for 30 days. Echocardiographic study was performed at baseline and follow-up. LV diastolic function was evaluated by two dimensional and Doppler echocardiography as follows; average E/e‫,׳‬ septal and lateral e‫׳‬ velocity, and left atrium volume index (LAVI). A total of 28 patients completed the study. A statistically significant improvement was observed in the CoQ10 treatment group in terms of average E/e‫׳‬ (18.9 (3.8) vs. 15.1 (4.3); p < 0.01) and LAVI (32 (9) mL/m 2 vs. 26 (7) mL/m 2 ; p < 0.05) and in the control group (18.4 (3.1) vs. 15.8 (5.6); p < 0.05) and (33 (7) mL/m 2 vs. 30 (8) mL/m 2 ; p < 0.05, respectively). However, there was no difference in change reduction between groups (∆E/e‫׳‬-3.6 vs.-2.4; p = 0.28) and (∆LAVI-5.4 vs.-4.4; p = 0.83). Short term CoQ10 supplementation provided no additional benefits in improving LV diastolic function in patients with HFpEF.

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Heart failure with reduced ejection fraction, ischemic heart disease, trimetazidine, global longitudinal strain, LV contractile Heart failure with reduced ejection fraction (HFrEF) due to ischemic heart disease (IHD) showed a progressive decline in left ventricular contractile function. However, no previous study has examined the left ventricular global longitudinal strain (LV GLS) parameter that represents LV contractile function. We investigated whether trimetazidine could improve the LV GLS value in patients with HFrEF due to IHD. We performed a double-blind, randomized controlled trial (RCT) including 26 patients with HFrEF due to stable IHD who were given modified-release trimetazidine 35 mg twice per day (n = 13) or placebo (n = 13) for 3 months in addition to standard medication. Left ventricular systolic function including GLS values was assessed at baseline and after 3 months using echocardiography. A total of 25 participants (13 control and 12 trimetazidine groups) were recruited with a baseline average age of 57.1 ± 10 years, and LV ejection fraction (LVEF) value of 34.6% ± 4.4%, and a GLS value of 7.4% ± 2.1%. Baseline clinical characteristics and echocardiogram were similar between the two groups. There was significant GLS improvement in the trimetazidine group (−6.9% ± 2.4% to −8.4% ± 2.6%, p = 0.000), but no significant differences were noted in the control group. The GLS improvement was significantly higher in the trimetazidine group than the control (1.5% + 0.9% vs. −0.7% + 1.7%, p = 0.001). No adverse drug reactions from the administration of trimetazidine in this study. Trimetazidine may improve GLS values in patients with HFrEF due to IHD.

Latar Belakang: Jumlah CD4 merupakan parameter penting pada penderita HIV dan berhubungan dengan peningkatan risiko disfungsi sistolik. Hingga saat ini, korelasi antara jumlah CD4 dengan parameter global longitudinal strain (GLS) sebagai indikator fungsi sistolik subklinis masih belum jelas. Metode: Penelitian ini merupakan studi observasional dengan metode belah lintang. GLS ventrikel kiri diperiksa menggunakan ekokardiografi dua dimensi. Jumlah CD4 baseline dan nadir diperoleh dari rekam medis sedangkan jumlah CD4 aktual dan CD4 percentage (CD4%) diperiksa menggunakan metode flow cytometry. Hasil: Total 37 pasien HIV asimptomatik mengikuti penelitian dengan rerata umur 31,95± 7,54 tahun dan median durasi penggunaan ARV adalah 34 bulan. Median CD4 baseline dan CD4 nadir adalah 272 sel/uL dan 223 sel/uL, sedangkan rerata CD4 aktual dan CD4% adalah 516,08±252,03 sel/uL dan 19,66±7,97 %. Semua subyek penelitian memiliki fungsi sistolik normal. Rerata GLS ventrikel kiri adalah 17,02±0,71. GLS ventrikel kiri berkorelasi positif dengan CD4 aktual (r=0,43; p=0,008) dan CD4% (r=0,349; p=0,034). Penderita HIV dengan jumlah CD4 aktual ?400 sel/uL memiliki GLS ventrikel kiri yang lebih baik dibandingkan dengan yang <400 sel/uL (p=0,022). Kesimpulan: Jumlah CD4, terutama CD4 aktual dan CD4 percentage berkorelasi dengan disfungsi sistolik subklinis yang diukur dengan global longitudinal strain pada penderita HIV asimtomatik. Hal ini mungkin dapat menjelaskan peran CD4 terhadap patogenesis gagal jantung pada penderita HIV.