Trimetazidine, a Metabolic Modulator, Has Cardiac and Extracardiac Benefits in Idiopathic Dilated Cardiomyopathy

Abstract

Background-The anti-ischemic agent trimetazidine improves ejection fraction in heart failure that is hypothetically linked to inhibitory effects on cardiac free fatty acid (FFA) oxidation. However, FFA oxidation remains unmeasured in humans. We investigated the effects of trimetazidine on cardiac perfusion, efficiency of work, and FFA oxidation in idiopathic dilated cardiomyopathy. Methods and Results-Nineteen nondiabetic patients with idiopathic dilated cardiomyopathy on standard medication were randomized to single-blind trimetazidine (nϭ12) or placebo (nϭ7) Pϭ0.027). The degree of ␤-blockade and trimetazidine interacted positively on ejection fraction. Plasma high-density lipoprotein concentrations increased 11% (PϽ0.001). Conclusions-In idiopathic dilated cardiomyopathy with heart failure, trimetazidine increased cardiac function and had both cardiac and extracardiac metabolic effects. Cardiac FFA oxidation modestly decreased and myocardial oxidative rate was unchanged, implying increased oxidation of glucose. Trimetazidine improved whole-body insulin sensitivity and glucose control in these insulin-resistant idiopathic dilated cardiomyopathy patients, thus hypothetically countering the myocardial damage of insulin resistance. Additionally, the trimetazidine-induced increase in ejection fraction was associated with greater ␤1-adrenoceptor occupancy, suggesting a synergistic mechanism. (Circulation.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

“…Trimetazidyna wykazuje dodatkową korzyść jako dodatek do LBA u pacjentów z HF i współistniejącą dławicą [400][401][402][403][404][405][406]. Istnieją dane sugerujące poprawę klasy czynnościowej NYHA, funkcji LV oraz wydłużenie czasu trwania wysiłku u pacjentów z HFrEF [402][403][404][405][406].…”

“…Istnieją dane sugerujące poprawę klasy czynnościowej NYHA, funkcji LV oraz wydłużenie czasu trwania wysiłku u pacjentów z HFrEF [402][403][404][405][406]. Kilka innych skutecznych leków przeciwdławicowych (np.…”

Positron emission tomography: An additional prognostic tool in dilated cardiomyopathy?

“…The feasibility to image by PET the RV together with the LV allows to get information on biventricular involvement in the disease process. Further studies would be needed to document whether earlier recognition of this altered biventricular substrate could help to better select responders to treatment including cardiac resynchronization and metabolic modulators 29 or should be used to early address patients to cardiac transplantation. The availability of hybrid PET/MR scanners 30 could allow in the future an even more comprehensive evaluation of DCM patients adding together multiple prognostic indicators spanning from biventricular function, to myocardial damage analysis to qualitative and possibly quantitative evaluation of biventricular flow and metabolism.…”

Similar patterns of myocardial metabolism and perfusion in patients with type 2 diabetes and heart disease of ischaemic and non-ischaemic origin

“…Electrocardiogram, systolic and diastolic blood pressure (BP), heart rate, body weight and height of each patient were recorded in resting conditions. Baseline systemic vascular resistances (SVRs) were calculated as follows: SVR ¼ MABP= SV Â HR ð Þ , where MABP is the mean arterial BP, SV is stroke volume and HR is heart rate [18].…”