Cardioprotective effect of trimetazidine in severe ischemic cardiomyopathy

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Abstract
The aim of this study was to assess the value of long-term treatment with 60 mg per day of trimetazidine, a cellular antlischemic agent, in comparison with placebo, in patients with ischemic cardiomyopathy controlled by conventional treatments. Twenty patients, with a mean age of 59.5 ±1.6 years, suffering from severe ischemic cardiomyopathy (NYHA IV, 6 patients; NYHA III, 14 patients) confirmed by coronary angiography, were included in the study; four of them suffered from residual angina. All of these patients were receiving long-term treatment with long-acting nitrates associated with digitalis (9 patients), diuretics (15 patients), anticoagulants (13 patients), and antiarrhythmics (11 patients), and were considered to be stabilized at the time of inclusion in the study. The examinations consisted of clinical and laboratory assessment, resting ECG, 24-hour ECG monitoring, X-ray evaluation of cardiac volume (CV), and evaluation of echocardiographic left ventricular shortening (ELVS) and of isotopic ejection fraction (EF). These three parameters were expressed as a percentage variation with respect to the initial value, and their variation between the two groups was compared by means of two-way analysis of variance. Clinically, the therapeutic benefit provided by trimetazidine resulted in: a) an improvement of dyspnea in all patients treated with trimetazicine compared with only one patient with placebo (p < 0.001), b) resolution of residual angina, which was unchanged with placebo, c) reduced requirements for complementary treatments (a single case versus eight cases in the placebo group; p < 0.01). This clinical improvement was corroborated by a significant difference in the variation between the two groups for CV (p=0.03) and EF (p=0.02), and a nonsignificant variation for ELVS (p=0.09). The results demonstrated the beneficial effect of trimetazidine in the long-term treatment of ischemic cardiomyopathy without any associated adverse effects.