Targeting Cardiac Metabolism for Therapy in Heart Failure: Will It Work?

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Abstract

Objectives.

This study sought to assess whether the long-term addition of trimetazidine to conventional treatment could improve functional class, exercise tolerance, and left ventricular (LV) function in patients with heart failure (HF).

Background.

Previous small studies have shown that trimetazidine may be beneficial in terms of preservation of LV function and control of symptoms in patients with postischemic HF.

Methods.

Fifty-five patients with HF were randomly allocated in an open-label fashion to either conventional therapy plus trimetazidine (20 mg 3 times daily) (28 patients) or conventional therapy alone (27 patients). Mean follow-up was 13±3 months. At study entry and at follow-up, all patients underwent exercise testing and 2-dimensional echocardiography. Among other parameters, New York Heart Association (NYHA) functional class and ejection fraction (EF) were evaluated.

Results.

In the trimetazidine group, NYHA functional class significantly improved compared with the conventional therapy group (P<.0001). Treatment with trimetazidine significantly decreased LV end-systolic volume (from 98±36 mL to 81±27 mL; P=.04) and increased EF from 36%±7% to 43%±10% (P=.002). In contrast, in the conventional-therapy group both LV end-diastolic and -systolic volumes increased from 142±43 mL to 156±63 mL; P=.2, and from 86±34 mL to 104±52 mL; P=.1, respectively; accordingly, EF significantly decreased from 38%±7% to 34%±7% (P=.02).

Conclusions.

Long-term trimetazidine improves functional class and LV function in patients with HF. This benefit contrasts with the natural history of the disease, as shown by the decrease of EF in patients on standard HF therapy alone.

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