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Heart. 2011 Sep;97(18):1495-500. doi: 10.1136/hrt.2011.226332. Epub 2011 Jun 23.

Effect of partial inhibition of fatty acid oxidation by trimetazidine on whole body energy metabolism in patients with chronic heart failure.

Author information

1
Division of Metabolic and Cardiovascular Sciences, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy. gabriele.fragasso@hsr.it

Abstract

OBJECTIVE:

Trimetazidine may have beneficial effects on left ventricular (LV) function in patients with systolic heart failure. The authors assessed whether long-term addition of trimetazidine to conventional treatment could improve, along with LV function, resting whole body energy metabolism in patients with chronic systolic heart failure.

DESIGN:

Single blind randomised study.

SETTING:

University Hospital.

PATIENTS:

44 patients with systolic heart failure receiving full medical treatment.

INTERVENTIONS:

Indirect calorimetry and two-dimensional echocardiography at baseline and after 3 months.

MAIN OUTCOME MEASURES:

Whole body resting energy expenditure (REE), percentage of predicted REE, LV ejection fraction (EF), NYHA class, quality of life.

RESULTS:

Trimetazidine increased EF compared with conventional therapy alone (from 35±8% to 42±11% vs from 35±7% to 36±6%; p=0.02, analysis of variance for repeated measures). NYHA class and quality of life also improved compared with conventional therapy (p<0.0001). REE (from 1677±264 to 1580±263 kcal/day) and percentage of predicted REE (based on the Harris-Benedict equation: from 114±10% to 108±9%) decreased in the trimetazidine group, but not in the control group (REE from 1679±304 to 1690±337 kcal/day and percentage of predicted REE from 113±12% to 115±14%). The variation was different between groups (p=0.03 and 0.023, respectively).

CONCLUSIONS:

In patients with systolic heart failure, improvement in functional class and LV function induced by middle-term trimetazidine therapy is paralleled by a reduction in whole body REE. The beneficial cardiac effects of trimetazidine may be also mediated by a peripheral metabolic effect.

PMID:
21700755
DOI:
10.1136/hrt.2011.226332
[Indexed for MEDLINE]

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