Short- and long-term beneficial effects of trimetazidine in patients with diabetes and ischemic cardiomyopathy

Fragasso, Gabriele; Piatti, Pier Marco; Monti, Lucilla D.; Palloshi, Altin; Setola, Emanuela; Puccetti, P; Calori, Giliola; Lopaschuk, Gary D.; Margonato, Alberto

doi:10.1016/s0002-8703(03)00415-0

Cited by 178 publications

(151 citation statements)

References 33 publications

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“…Figure 2). 51 In patients with ischaemic cardiomyopathy, the trimetazidine treatment was associated not only to functional improvement and reduction in hospitalisations and mortality, but also with a significant positive effect on ventricular remodeling. 48,49,[55][56][57][58] In several subsequent studies, the similar finding was confirmed, based on both global and regional LV systolic function improvement, as well as the enhancement of LV diastolic function.…”

Section: Trimetazidine In Heart Failurementioning

confidence: 98%

“…51 In patients with ischaemic cardiomyopathy, the trimetazidine treatment was associated not only to functional improvement and reduction in hospitalisations and mortality, but also with a significant positive effect on ventricular remodeling. 48,49,[55][56][57][58] In several subsequent studies, the similar finding was confirmed, based on both global and regional LV systolic function improvement, as well as the enhancement of LV diastolic function. [48][49][50]59 Furthermore, the improvement of LV remodelling processes and the reduction of the plasma inflammatory response, natriuretic peptides, cardiac troponin levels and a recovery of the endothelium-dependent relaxation of conduit arteries was shown.…”

Section: Trimetazidine In Heart Failurementioning

confidence: 98%

“…Benefical effects include improving NYHA functional class, exercise tolerance, QoL, LVEF and cardiac volumes (see Table 2). [48][49][50][51][52][53][54] Among the first reports was the study of Brottier et al who analysed clinical results with long-term treatment with trimetazidine on top of conventional therapy. 50 After follow up of 6 months, improvement of LVEF by 9.…”

Section: Trimetazidine In Heart Failurementioning

confidence: 99%

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

Milinković

Rosano

Lopatin

et al. 2016

Cardiac Failure Review

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TherapeuticsAccess at: www.CFRjournal.com Chronic heart failure (HF), a complex and heterogeneous clinical syndrome, is a major cause of morbidity and mortality worldwide, and represents a major challenge to health care systems. The prevalence of HF and the number of hospitalisations is rising, even more in the ageing population.1 The direct costs of HF management reached 1-2 % of total health care expenditure and approximately two-thirds are attributable to hospitalisations. In 2012, in 197 countries, covering 99 % of the world's population, the overall cost of HF management was estimated at US$108 billion per annum, and is predicted to rise. 4 Around 60 % of total HF patients has HFrEF, which is associated with high reninangiotensin-aldosterone and sympathetic nervous systems activation.Most recent therapeutic improvements in these patients are due to the use of pharmacological agents that modulate these neuro-hormonal axes, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers and mineralocorticoid receptor antagonists (MRAs). The beneficial effects of these treatments include the reduction of HF mortality by approximately one-third in a period of two decades. Despite this success, HF mortality rates remain high:the 5-year survival is worse than in many cancers. 5,6The 2016 European Society of Cardiology (ESC) HF guidelines recommend ACEI and beta-blockers as first-line therapy in symptomatic patients with HFrEF. 4 However, both registries and clinical reports underline that the treatment of HF patients is suboptimal much more than expected, and that the heart rate is increased despite beta-blocker therapy.7-12 The registry of 12,440 patients demonstrated heterogeneity in treatment strategies, due to the drug side effects and contraindications.7 A European registry 13 reported that only 17 % of patients were receiving the optimal combination and recommended dose of diuretic, ACEI and beta-blockers. Results from a French registry on 50,000 HF patients 14 also confirmed suboptimal treatment of HF, demonstrating that after the first month following hospitalisation for worsening HF, only 47 % received an ACEI, 54 % a beta-blocker, and 17 % MRAs. The I Brazilian Registry of Heart Failure (BREATHE) 15 , conducted in 57 hospitals in Brazil, revealed that 69 % of HF patients were receiving an ACEI or ARB, 60 % a beta-blocker, and 49 % MRAs. However, only 17 % were receiving all three drugs together. Therefore, a need to identify a novel pathways and strategies for HF treatment is obvious and clinically justified. This article reviews the clinical evidence and guidelines recommendations for the use of two novel therapies in HF: ivabradine and trimetazidine. AbstractThe prevalence of heart failure (HF) is increasing, representing a major cause of death and disability, and a growing financial burden on healthcare systems. Despite the use of effective treatments with both drugs and devices, mortality remains high. There is therefore a need for new and effective therapeutic a...

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Section: Trimetazidine In Heart Failurementioning

confidence: 98%

Section: Trimetazidine In Heart Failurementioning

confidence: 98%

Section: Trimetazidine In Heart Failurementioning

confidence: 99%

See 1 more Smart Citation

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

Milinković

Rosano

Lopatin

et al. 2016

Cardiac Failure Review

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“…Aplicados os critérios de elegibilidade, dois revisores selecionaram nove estudos para leitura na íntegra. Desses, foram incluídos nove artigos completos, sendo oito ensaios clínicos (Fragasso et al, 2003;Marazzi et al, 2007;Ribeiro et al, 2007;Rosano et al, 2003;Szwed et al, 1999;Thrainsdottir et al, 2004;Xu et al, 2014;Zhao et al, 2013) e um estudo observacional pós-comercialização (Rodríguez Padial et al, 2005), a fim de embasar as evidências científicas do uso de TMZ. O fluxograma de seleção de artigos está apresentado no Apêndice 1.…”

Section: Clínicosunclassified

Custo-efetividade de trimetazidina no tratamento de angina estável em pacientes diabéticos não respondedores a betabloqueadores, nitratos e bloqueadores do canal de cálcio

Cesar¹,

Pepe²,

Arinelli³

2017

JBES

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RESUMOObjetivo: Avaliar o custo-efetividade da trimetazidina (TMZ) associada ao tratamento convencional (diurético, ácido acetilsalicílico [AAS], betabloqueador, inibidores da enzima de conversão da angiotensina (IECA), nitrato, estatina, digitálico e antagonista dos canais de cálcio) versus tratamento convencional isolado no tratamento de pacientes diabéticos com angina estável não respondedores a betabloqueadores, nitratos e bloqueadores do canal de cálcio sob a perspectiva do Sistema Público de Saúde (SUS). Métodos: Foi elaborado um modelo de Markov, com ciclos de 1 ano, que acompanhou os pacientes ao longo do curso natural da doença até o final de suas vidas. Dados clínicos foram obtidos a partir de revisão da literatura. Custos unitários foram extraídos de bases de dados oficiais. Apenas custos médicos diretos foram contemplados. Custos e benefícios foram descontados a uma taxa de 5% ao ano. Desfecho clínico foi expresso como episódio de hospitalização por angina pectoris (EHAP) evitado. Análise de sensibilidade univariada foi realizada para determinar os parâmetros de maior influência nos resultados, variando-os em mais ou menos 20% comparado ao cenário base. Resultados: O tratamento com TMZ mostrou maior benefício comparado ao tratamento convencional e gerou uma Razão de Custo-Efetividade Incremental de R$ 7.344,96 por EHAP evitado. O parâmetro de maior impacto no resultado foi o número de episódios de angina pectoris. Apesar do alto impacto, este não alterou o resultado da análise, mantendo-o custo-efetivo. Conclusão: TMZ associada ao tratamento convencional mostrou ser uma alternativa eficaz, segura e custo-efetiva para o tratamento de pacientes diabéticos com angina estável não respondedores a betabloqueadores, nitratos e bloqueadores do canal de cálcio. ABSTRACTObjective: To assess the cost-effectiveness analysis of trimetazidine (TMZ) associated with conventional treatment (diuretic, acetylsalicylic acid [ASA], beta blocker, angiotensin converting enzyme inhibitor (ACEI), nitrate, statine, digitalis and calcium channel antagonist) versus conventional treatment alone in the treatment of diabetic patients with stable angina non-responders to beta blockers, nitrates and calcium channel blockers from the perspective of the Public Health System (SUS). Methods: A Markov model was developed, with one year cycles, to follow the patients along the natural course of disease until the end of your lifes. Clinical data were obtained from the literature

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“…Although FAO is an important source of energy production during the basic conditions, glucose uptake may be crucial during ischemia. It is believed that partial inhibition of FAO and a substrate switch from FA to glucose improves functional recovery of the heart upon reperfusion (Fragasso et al 2003) while overexpression of PPAR-α impairs postischemic cardiac recovery (Sambandam et al 2006). Thus, pharmacological interventions that increase glucose oxidation and suppress FAO appear to be beneficial for the recovery of the myocardium previously subjected to I/R (Kantor et al 2000;Panagia et al 2005).…”

Section: Ppar Function and The Outcome Of Myocardial Ischemia/reperfumentioning

confidence: 99%

The role of PPAR in myocardial response to ischemia in normal and diseased heart

Ravingerová¹,

Adameová²,

Čarnická³

et al. 2012

gpb

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Abstract. Peroxisome proliferator-activated receptors (PPAR), ligand-activated transcription factors, belong to the nuclear hormone receptor superfamily regulating expression of genes involved in different aspects of lipid metabolism, inflammation and cardiac energy production. Activation of PPAR-α isoform by its natural ligands, fatty acids (FA) and eicosanoids, promotes mitochondrial FA oxidation as the primary ATP-generating pathway. On the other hand, PPAR-γ regulates lipid anabolism or storage, while, until recently, the function of PPAR-β/δ has been less explored. Under conditions associated with acute or chronic oxygen deprivation, PPAR-α modulates expression of genes that determine substrate switch (FA vs. glucose) aimed at maintenance of basic cardiac function. Although PPAR-α and PPAR-γ synthetic agonists, hypolipidemic and antidiabetic drugs, have been reported to protect the heart against ischemia/ reperfusion injury, it is still a matter of debate whether PPAR activation plays a beneficial or detrimental role in myocardial response to ischemia, in particular, in pathological conditions. This article reviews some findings demonstrating the impact of PPAR activation on cardiac resistance to ischemia in normal and pathologically altered heart. Specifically, it addresses the issue of susceptibility to ischemia in the diabetic myocardium, with particular regards to the role of PPAR. Finally, involvement of PPAR in the mechanisms of lipid-independent cardioprotective effects of some hypolipidemic drugs is also discussed.

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Short- and long-term beneficial effects of trimetazidine in patients with diabetes and ischemic cardiomyopathy

Cited by 178 publications

References 33 publications

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

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

Custo-efetividade de trimetazidina no tratamento de angina estável em pacientes diabéticos não respondedores a betabloqueadores, nitratos e bloqueadores do canal de cálcio

The role of PPAR in myocardial response to ischemia in normal and diseased heart

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Short- and long-term beneficial effects of trimetazidine in patients with diabetes and ischemic cardiomyopathy

Cited by 178 publications

References 33 publications

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

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

Custo-efetividade de trimetazidina no tratamento de angina estável em pacientes diabéticos não respondedores a betabloqueadores, nitratos e bloqueadores do canal de cálcio

The role of PPAR in myocardial response to ischemia in normal and diseased heart

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The role of PPAR in myocardial response to ischemia in normal and diseased heart