Additional use of trimetazidine in patients with chronic heart failure: a meta-analysis.

Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China.
Journal of the American College of Cardiology (Impact Factor: 14.09). 03/2012; 59(10):913-22. DOI:10.1016/j.jacc.2011.11.027
Source: PubMed

ABSTRACT The aim of this meta-analysis was to evaluate the effects of additional trimetazidine (TMZ) treatment on patients with chronic heart failure (CHF).
Conflicting results currently exist on the clinical use of TMZ in CHF patients.
PubMed, MEDLINE, EMBASE, and EBM Reviews databases were searched through November 2010 for randomized controlled trials (RCTs) assessing TMZ treatment in CHF patients. Data concerning the study design, patient characteristics, and outcomes were extracted. Risk ratio (RR) and weighted mean differences (WMD) were calculated using fixed or random effects models.
Sixteen RCTs involving 884 CHF patients were included. Hospitalization for cardiac causes (RR: 0.43, p = 0.03), but not all-cause mortality (RR: 0.47, p = 0.27), was reduced by TMZ treatment. Moreover, TMZ therapy was associated not only with the increase of left ventricular ejection fraction (WMD: 6.46%, p < 0.0001) and total exercise time (WMD: 63.75 seconds, p < 0.0001), but also with the decrease of New York Heart Association functional class (WMD: -0.57, p = 0.0003), left ventricular end-systolic diameter (WMD: -6.67 mm, p < 0.0001), left ventricular end-diastolic diameter (WMD: -6.05 mm, p < 0.0001), and B-type natriuretic peptide (WMD: -203.40 pg/ml, p = 0.0002).
Additional use of TMZ in CHF patients may decrease hospitalization for cardiac causes, improve clinical symptoms and cardiac function, and simultaneously ameliorate left ventricular remodeling.

0 0
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Heart failure (HF) is characterized by an impaired ability of the ventricle to fill with and eject blood commensurate with the metabolic demands and requirements of the body, and has emerged as a major cause of morbidity and mortality in the developed world. Approximately 50% of HF patients have preserved ejection fraction, and lack overt signs of systolic failure, but rather have deficits in ventricular relaxation indicative of diastolic dysfunction/HF. Systolic HF and diastolic dysfunction/HF share a num-ber of risk factors including age, myocardial ischemia, hypertension, obesity, and diabetes. As such these risk factors may be of limited utility in discriminating between the two HF phenotypes. However, differences in ventricular remodeling and ventricular function can readily differentiate systolic HF from diastolic dysfunction/HF. To date, a common modality to improve the status of both HF entities remains to be found. As therapeutic interventions that optimize cardiac energy metabolism have proven useful in the management of systolic HF, and because ventricular relaxation is an energy-dependent process, a better understanding of the alterations in energy metabolism in diastolic dysfunction/HF may identify novel treatment strategies for this cardiac pathology.
    Heart and Metabolism 12/2012; 57:4-7.
  • [show abstract] [hide abstract]
    ABSTRACT: Although the management of chronic heart failure (CHF) has made enormous progress over the past decades, CHF is still a tremendous medical and societal burden. Metabolic remodeling might play a crucial role in the pathophysiology of CHF. The characteristics and mechanisms of metabolic remodeling remained unclear, and the main hypothesis might include the changes in the availability of metabolic substrate and the decline of metabolic capability. In the early phases of the disease, metabolism shifts toward carbohydrate utilization from fatty acids (FAs) oxidation. Along with the progress of the disease, the increasing level of the hyperadrenergic state and insulin resistance cause the changes that shift back to a greater FA uptake and oxidation. In addition, a growing body of experimental and clinical evidence suggests that the improvement in the metabolic capability is likely to be more significant than the selection of the substrate.
    Journal of Zhejiang University SCIENCE B 08/2013; 14(8):688-95. · 1.11 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Heart failure (HF) is associated with changes in myocardial metabolism that lead to impairment of contractile function. Trimetazidine (TMZ) modulates cardiac energetic efficiency and improves outcomes in ischemic heart disease. We evaluate the effects of TMZ on left ventricular ejection fraction (LVEF), cardiac metabolism, exercise capacity, O2 uptake and quality of life (QoL) in patients with non-ischemic HF. Randomized, double-blind study. Sixty patients with stable non-ischemic HF under optimal medical therapy were included. Patients were randomized to TMZ 35 mg p.o. bid or placebo for 6 months. LVEF, 6-minute walk test (6MWT), maximum O2 uptake in cardiopulmonary exercise test ,different markers of metabolism, oxidative stress and endothelial function as well as quality of life were assessed at baseline and after TMZ treatment. LV peak glucose uptake was evaluated using the maximum standardized uptake value (SUV) by 18-fluorodeoxyglucose positron emission tomography ((18)FDG PET). Etiology was idiopathic in 85% and hypertensive in 15%. Both groups were similar in age, functional class, LVEF and levels of N-terminal pro-BNP at baseline. After 6 months of TMZ treatment, no changes were observed in LVEF (31 ± 10 vs. 34 ± 8% respectively, p = 0.8), 6MWT (443 ± 25 vs. 506 ± 79 meters, p=0.03), maximum O2 uptake (19.1 ± 5.0 vs 23.0 ± 7.2 mL/kg/min, p=0.11), functional class (percentage of patients in functional class I/II/III/IV 10/3753/0 in TMZ vs. 7/40/50/3 in placebo, p=0.14) or QoL (32±26 vs. 24±18 points, p = 0.25) . In the subgroup of patients evaluated with (18)FDG PET, no significant differences were observed in SUV between both groups (7.0 ± 3.6 vs. 8.2 ± 3.4 respectively; p = 0.47). In patients with non-ischemic HF, the addition of TMZ to optimal medical treatment does not result in significant changes of LVEF, exercise capacity, O2 uptake or quality of life.
    Journal of cardiac failure 01/2014; · 3.25 Impact Factor


Available from

Lei Zhang