Therapeutic value of a cardioprotective agent in patients with severe ischaemic cardiomyopathy

Abstract

Trimetazidine (TMZ) has been shown to have anti-ischaemic properties improving exercise tolerance without haemodynamic effects. A 6-month double-blind placebo-controlled study was carried out in 20 patients, mean age 59 +/- 6 years, to examine the benefit of adding 60 mg of TMZ vs placebo to the classical therapy, excluding those previously treated with calcium-antagonists, conversion enzyme inhibitors, vasodilators and antiplatelet agents. All patients had severe ischaemic cardiomyopathy, confirmed by coronary angiography; six were in NYHA class IV; 14 in NYHA class III; four had mild recurrent angina pectoris. assessment included clinical and biological evaluation, electrocardiography (ECG), 24-h ECG monitoring, cardiac volume evaluation with chest X-ray, left ventricular fractional shortening by echocardiography, left ventricular ejection fraction by radionuclide angiography. Baseline characteristics were similar in placebo (11 patients) and TMZ (nine patients) groups. Eighteen patients (nine in each group) were followed up for 6 months. In eight patients of the placebo group, treatment had to be modified (addition of calcium antagonists: four patients, conversion enzyme inhibitors: two patients; digitalics: one patient; diuretics: one patient). In the TMZ group, digitalic therapy was withdrawn in one patient and added in one patient (P less than 0.01). At 6 months, all TMZ group patients were free from angina; dyspnoea was improved in all TMZ patients and in only one placebo patient (P less than 0.001). Ejection fraction, increased by 9.3% in the TMZ group and decreased by 15.6% in the placebo group (P less than 0.018), CV decreased by 7% with TMZ, increased by 4% with placebo. (P = 0.034).(ABSTRACT TRUNCATED AT 250 WORDS)

Suppression of Angioplasty-Related Inflammation by Pre-Procedural Treatment with Trimetazidine

“…Preliminary clinical studies tend to confirm a direct benefit of a metabolic approach with TMZ in left ventricular dysfunction (Wildhirt et al 1999;Zhao et al 2000;Belardinelli and Purcaro 2001). A significant improvement in ejection fraction was also found with TMZ, compared with placebo, in a group of patients undergoing PTCA (Brottier et al 1990;Birand et al 1998). Recent studies have found that TMZ protects from dobutamine-induced ischemia and improves resting ventricular function (Lu et al 1998;Belardinelli and Purcaro 2001).…”

Trimetazidine: a new concept in the treatment of angina. Comparison with propranolol in patients with stable angina. Trimetazidine European Multicenter Study Group.

“…Beneficial placebo [2][3][4][5] and nifedipine [6]. An unchanged rate x effects have also been reported in ischaemic cardiopressure product at rest and at peak exercise in humans myopathy [10] and during coronary artery bypass surgery [3,4,6], and unchanged coronary blood flow in dogs [7] [11]. Brottier et al [10] reported that trimetazidine suggest that trimetazidine may exert its anti-ischaemic significantly improved clinical status and isotopic ejection Correspondence: Professor J. M. Detry, Saint-Luc University Hospital, Division of Cardiology, 10 avenue Hippocrate, B 1200 Brussels, Belgium fraction, and decreased cardiac volume after 6 months treatment.…”

“…In a placebo-controlled study Brottier et al. [10] reported that trimetazidine improved clinical status and ejection fraction, and decreased cardiac volume in patients with severe ischaemic cardiomyopathy. In a placebo-controlled study the antiischaemic effects of intracoronary administration of 6 mg trimetazidine were investigated during percutaneous transluminal coronary angioplasty [9].…”

The Role of Ivabradine and Trimetazidine in the New ESC HF Guidelins

“…48,49,[55][56][57][58] In several subsequent studies, the similar finding was confirmed, based on both global and regional LV systolic function improvement, as well as the enhancement of LV diastolic function. [48][49][50]59 Furthermore, the improvement of LV remodelling processes and the reduction of the plasma inflammatory response, natriuretic peptides, cardiac troponin levels and a recovery of the endothelium-dependent relaxation of conduit arteries was shown. 48,49,56,59 These results were obtained in HF patients with ischaemic aetiology while no effects of trimetazidine in patients with HF of nonischaemic aetiology was revealed.…”

“…Benefical effects include improving NYHA functional class, exercise tolerance, QoL, LVEF and cardiac volumes (see Table 2). [48][49][50][51][52][53][54] Among the first reports was the study of Brottier et al who analysed clinical results with long-term treatment with trimetazidine on top of conventional therapy. 50 After follow up of 6 months, improvement of LVEF by 9.…”