Is Treatment with Trimetazidine Beneficial in Patients with Chronic Heart Failure?

Abstract

BackgroundWhether additional benefit can be achieved with the use of trimetazidine (TMZ) in patients with chronic heart failure (CHF) remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of TMZ treatment in CHF patients.MethodsWe searched PubMed, EMBASE, and Cochrane databases through October 2013 and included 19 RCTs involving 994 CHF patients who underwent TMZ or placebo treatment. Risk ratio (RR) and weighted mean differences (WMD) were calculated using fixed or random effects models.ResultsTMZ therapy was associated with considerable improvement in left ventricular ejection fraction (WMD: 7.29%, 95% CI: 6.49 to 8.09, p<0.01) and New York Heart Association classification (WMD: −0.55, 95% CI: −0.81 to −0.28, p<0.01). Moreover, treatment with TMZ also resulted in significant decrease in left ventricular end-systolic volume (WMD: −17.09 ml, 95% CI: −20.15 to −14.04, p<0.01), left ventricular end-diastolic volume (WMD: −11.24 ml, 95% CI: −14.06 to −8.42, p<0.01), hospitalization for cardiac causes (RR: 0.43, 95% CI: 0.21 to 0.91, p = 0.03), B-type natriuretic peptide (BNP; WMD: −157.08 pg/ml, 95% CI: −176.55 to −137.62, p<0.01) and C-reactive protein (CRP; WMD: −1.86 mg/l, 95% CI: −2.81 to −0.90, p<0.01). However, there were no significant differences in exercise duration and all-cause mortality between patients treated with TMZ and placebo.ConclusionsTMZ treatment in CHF patients may improve clinical symptoms and cardiac function, reduce hospitalization for cardiac causes, and decrease serum levels of BNP and CRP.

The Role of Ivabradine and Trimetazidine in the New ESC HF Guidelins

“…66 In a meta-analysis of 19 RCTs involving 994 HF patients on treatment with trimetazidine or placebo, trimetazidine However, there were no significant differences in exercise duration and all-cause mortality between patients treated with trimetazidine and placebo. 67 Adverse effects associated with trimetazidine have been minor and mostly gastrointestinal. However, retrospective studies have found an association between long-term use of trimetazidine and Parkinson syndrome, gait disturbances and tremor.…”

Rationale for Application, and Benefits of Trimetazidine in Heart Failure by Its Influence of Myocardium Metabolism

“…При другом мета-анализе, выполненном Zhang, et al [65], с включением данных из 16 РКИ с участием в целом 884 пациентов с СН также было показано, что триметазидин уменьшил частоту госпитализаций по сердечно-сосудистым показаниям у пациентов с СН, однако не повлиял на общую смертность. Тре-тий мета-анализ, проведенный Zhou et Chen [66] с включением данных для 994 пациентов с СН из 19 РКИ, подтвердил уменьшение частоты госпитализа-ций по сердечно-сосудистым показаниям; однако достоверного различия по общей смертности между пациентами, получавшими триметазидин или пла-цебо, выявлено не было.…”

Real-world Evidence for the Antianginal Efficacy of Trimetazidine from the Russian Observational CHOICE-2 Study

“…It reduces the frequency of anginal episodes and improves exercise performance without affecting haemodynamic parameters [13,14]. Cardioprotection [15][16][17][18] has been demonstrated in both animal models [19,20] and patients, whether with CAD [14,[21][22][23][24] or heart failure [25][26][27][28]. TMZ acts by optimising ATP production directly at the cardiac cell level and opposing ischaemic change [16].…”