Trimetazidine improves exercise tolerance and left ventricular function in patients with contemporary treatment of chronic ischemic heart failure

Abstract

Purpose: To prospectively evaluate the effect of modified-release trimetazidine, as an addition to standard therapy, on functional class, exercise tolerance and left ventricular function in patients with ischemic heart failure. Methods: 48 patients with chronic heart failure were randomized in a crossover study to placebo or trimetazidine (modified release pill, 35 mg t.i.d.) for two periods of 90 days. At the end of each period, all patients underwent er-gospirometry, 2D echocardiography and physical examination. New York Heart Association (NYHA) class, left ventricular ejection fraction, plasma concentrations of NT-proBNP, interleukin-8 and adiponectin were evaluated. The patients were treated according to current standards, with >90% rate of beta-blocker and RAA-blockade use. Results: Compared with placebo, exercise time (trimetazidine (TMZ) 452,5± 145,6 s vs 413,3±147,5 s, p=0,039) and load (TMZ 117,5±44,9 vs 104,9± 43,8 Watt, p=0,046) during ergospirometry test, increased in the trimetazidine grup. Left ventricular ejection fraction increased 30,7±6,4% in patients treated with trimetazidine compared with 28,8±6,1% in those receiving placebo, p=0,043. On trimetazidine NYHA class decreased from 2,76±0,44 to 2,53± 0,50, p=0,03. Plasma levels of NT-proBNP decreased significantly in trimetazidine compared with placebo (TMZ 2507,2±1957,9 vs 2962,9±1902,3 pg/ml, p=0,048). Conclusions: The addition of trimetazidine to modern multidrug treatment improves exercise tolerance and left ventricular ejection fraction in patients with is-chemic heart failure. This is accompanied by a significant decrease in the level of NT-proBNP.