Effects of trimetazidine on ventricular remodeling in coronary artery disease patients with left ventricular hypertrophy: the rationale and design of a randomized controlled trial

Abstract

Background: Trimetazidine is a metabolic anti-ischemic agent, which increases the tolerance of cardiomyocytes to ischemia. However, few studies have explored the effect of trimetazidine on ventricular remodeling in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with left ventricular hypertrophy (LVH). Methods: It is a randomized, placebo-controlled trial, and we propose to recruit one hundred and twenty-four CAD patients undergoing PCI with LVH during a 12-month period. They will be randomized to receive either trimetazidine (35 mg twice a day) or placebo in the following 12 months after PCI. Blood tests, echocardiography, symptom of angina and major adverse cardiovascular events (MACEs) will be collected at follow-up visit at 3 and 12 months. The primary end point will be the left ventricular remodeling measured by left ventricular mass index (LVMI) at 3-and 12-month follow-up compared with the baseline. The secondary end points will be the symptom of angina assessed by Seattle Angina Questionnaire, myocardial ischemia measured by 6-min walk test and exercise electrocardiography test, as well as MACEs (defined as a composite of death, myocardial infarction, stroke, recurrent angina, re-hospitalization, change of viable myocardium). Discussion: This study aims to demonstrate the effect of trimetazidine on left ventricular remodeling and myocardial ischemia in CAD patients undergoing PCI with LVH. Trimetazidine treatment is likely to improve the left ventricular remodeling, symptoms of angina and myocardial ischemia. It might also reduce the risk of MACEs in CAD patients undergoing PCI with LVH.

The Impact of Trimetazidine on Cardiac Fibrosis, Inflammation, and Function in Ischemic Cardiomyopathy Patients

“…TMZ improves heart metabolism by altering the preferred energy substrate from fatty acid to glucose oxidation, thereby potentially playing an important role in improving myocardial function [ 23 ]. The drug’s effects on maintaining the integrity of cell membranes [ 2 ], as well as mitochondrial structure and function, may explain the improvement in the LVEF [ 2 , 40 ]. The increase in glucose oxidation caused by TMZ can improve contractility and microvascular function by promoting glycolytic ATP resynthesis.…”

Left Ventricular Remodeling and Heart Failure Predictors in Acute Myocardial Infarction Patients with Preserved Left Ventricular Ejection Fraction after Successful Percutaneous Intervention in Western Romania

“…In the acute MI phase, treatment with the anti-ischemic drug trimetazidine may restore energy supply, minimize mitochondrial damage, and limit ischemia/reperfusion harm. This medication is currently being studied to see if it can protect against persistent post-MI remodeling [ 34 ].…”

Multisystem effect of cytoprotection

“…Благодаря своему механизму действия триметазидин обеспечивает кардиопротекторный эффект у пациентов со стенокардией, сахарным диабетом и дисфункцией левого желудочка, а также у лиц, которые проходят процедуры реваскуляризации, без соответствующих побочных эффектов [8][9][10]. Кроме того, отсутствие влияния на ЧСС, артериальное давление и большинство частых сопутствующих заболеваний делают триметазидин привлекательным препаратом выбора как для пациентов, так и врачей.…”