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Adjunctive trimetazidine beneficial in chronic heart failure

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Adding trimetazidine to the treatment of chronic heart failure improves cardiac function and slows left ventricular remodeling, according to the results of a meta-analysis appearing in the March 6 issue of the Journal of the American College of Cardiology.

“Although the additional use of TMZ (trimetazidine) failed to reduce all-cause mortality in CHF patients, the beneficial effects have been demonstrated,” conclude Dr. Junbo Ge, at Zhongshan Hospital, Fudan University in Shanghai, China, and colleagues.

Trimetazidine, approved outside the US as an antianginal agent, has been shown to reduce oxidative damage and improve endothelial function, and is considered promising for CHF, they explain. However, trial results have been mixed.

The team therefore conducted a meta-analysis of data from 16 relevant randomized controlled trials involving 884 CHF patients. The results showed that hospitalizations for cardiac causes were reduced with the use of trimetazidine (risk ratio 0.43, p=0.03), but the reduction in all-cause mortality was not statistically significant (RR 0.47; p=0.27).

Also, trimetazidine was associated with increased LV ejection fraction (weighted mean difference 6.46%; p<0.0001), improved total exercise time (WMD 63.75 seconds; p<0.0001) and decreased NYHA class (WMD -0.57; p=0.0003), according to the report.

The authors also noted a beneficial effect on left ventricular end-systolic diameter (WMD: -6.67 mm, p< 0.0001), and end-diastolic diameter (WMD -6.05 mm; p<0.0001).

“Moreover,” Dr. Ge and colleagues add, “as illustrated by the unchanged resting blood pressure and an average decrease of a mere 2.6 beats/min in resting heart rate, our study indicated that the aforementioned beneficial effects may be hemodynamically neutral.”

Overall, they conclude the results show that trimetazidine “may be an additional therapeutic agent for CHF.”


Additional Use of Trimetazidine in Patients With Chronic Heart Failure : A Meta-Analysis

Journal of the American College of Cardiology, 2012; 59:913–922.