Myocardial damage biomarkers dynamics after extracardiac surgery in coronary heart disease patients taking trimetazidine MR

Abstract

Aim. To investigate on the influence of trimetazidine MR on biomarker dynamics of myocardial necrosis and heart failure in early post-surgery period in coronary heart disease (CHD) patients, undergoing extracardiac thoracal surgery. Material and methods. Totally, 72 men included, mean age 61,0 (57-66) y. o. Patients were randomized to the intervention group (n=35), receiving trimetazidine MR (Preductal MR®) 35 mg b. i.d., prescribed before operation for 2 weeks, and controls (n=37). In the studied groups, we assessed and compared perioperational troponin I dynamics, fatty acid binding protein (FABP) dynamics, and N-terminal pro-brain natriuretic peptide (NT-proBNP), measured the day before, and in 24 and 48 after surgery. Results. Baseline level for all biomarkers did not differ in groups. After the intervention, in both groups there was increase of troponin I, but not outside reference range. Troponin I >0,1 ng/mL was found in 2 patients from control group. Mean level of FABP increased after the operation in both groups. In 48 hours, in trimetazidine MR group, comparing to controls, the following were lower (p<0,05): median FABP (1,0 and 1,9 ng/mL, resp.) and part of patients with FABP >5,0 ng/mL (2,9% and 18,9%), medians of NT-proBNP, in 24 hours (184,0 and 293,3 pg/mL) and 48 hours (160,6 and 334,0 pg/mL) after surgery were also lower in trimetazidine MR group. In this group, in 48 hours after surgery NT-proBNP rarer reached the level of 300 pg/mL and higher (in 20,0% and 51,4%). The analogous result was found in subgroups of patients with baseline normal NT-proBNP. In these subgroups, the grade of NT-proBNP increase in 24 hours after surgery differed as well (by 160,3 and 242,2 pg/mL). Conclusion. The achieved results witness on the cardioprotective effect of trimetazidine MR in CHD patients under circumstances of perioperational myocardial stress, caused by an open extracardial operation.