Effects of sustained-release trimetazidine on chronically dysfunctional myocardium of ischemic dilated cardiomyopathy - Six months follow-up result

Abstract

Background: Ischemic cardiomyopathy is a growing burden in third world countries. So far, benefits of trimetazidine in this group of patients have been suggested by clinical trials mainly conducted in Europe. We evaluated the effect of trimetazidine on ischemic dilated cardiomyopathy in our population.

Methods and results: 98 patients (aged 58.5±9.2 years), admitted with decompensated heart failure with previous history of MI and/or documentation of significant CAD with previous CAG, were chosen for the study. Patients were randomized into two groups - one provided with trimetazidine 35mg sustained released tablet, twice daily and the other with a placebo, along with other conventional medications. Patients were included if they had dilated LV (LVIDd>57mm) and left ventricular ejection fraction (LVEF) ≤40%. After 6 months, significantly higher number of patients in trimetazidine group were in NYHA class I (22% vs. 8%, p=0.03) and class II (56% vs. 34%, p=0.01); higher number of patients in placebo group were in NYHA class III class IV. Anginal episodes and use of sublingual nitrate per week were significantly lower in the trimetazidine group. Left ventricular diastolic dimension (59.7±5.2 vs. 65.1±6.1, p=0.001) was significantly different in the two groups as was the increase of LVEF (11% vs. 5.6%, p=0.001). Hospitalization for worsening heart failure was significantly lower in trimetazidine group (13 vs. 22, p=0.047).

Conclusion: Trimetazidine seems to be beneficial in patients with ischemic dilated cardiomyopathy in South Asian population and larger scale study with extended follow-up is needed.

Keywords: Chronic heart failure; Ischemic cardiomyopathy; Trimetazidine.

Fig. 1

Heart failure NYHA class at 6 months in two groups.

Fig. 2

Anginal CCS class at 6 months in trimetazidine and placebo groups.

Fig. 3

Anginal attack and nitrate use rate per week at baseline and at 6 months.

Fig. 4

Left ventricular internal diameter in diastole and left ventricular ejection fraction in trimetazidine and placebo group at baseline and 6 months.

Fig. 5

LVEF after 6 months in two groups.

Fig. 6

Echocardiographic changes of LV dimensions and functions of study patients at baseline and after 6 months of trimetazidine over standard therapy.