Author + information
- Liang Yuanhong,
- Lin Chunying,
- Fei Hongwen,
- Liu Lie,
- Chen Dongli and
- Chen Silin
Left bundle branch block (LBBB) patients with dilated cardiomyopathy (DCM) remain highly symptomatic with a poor prognosis. As failure progresses, mitochondrial oxidative metabolism is reduced and glycolysis is increased with the down regulation of glucose and fatty acid oxidation. Trimetazidine may optimize myocardial energy metabolism and allow more efficient production of energy from glucose than from free fatty acids. However, the effects of trimetazidine in LBBB patients with DCM are not clear. In this study, we explore whether the addition of trimetazidine to the current standard treatment of heart failure could effectively improve heart function and physical tolerance in these patients.
Sixty consecutive LBBB patients with heart dysfunction (35%≤LVEF≤45%) were randomly allocated to conventional heart failure therapy plus trimetazidine (20 mg three times a day; 30 pts) or conventional therapy alone (30 pts). During 6 months follow-up, plasma NT-proBNP, 6-minute walk test (6MWT) and echocardiogram indexes were measured.
At 6 months, a significant functional improvement was noted in patients receiving trimetazidine added to their usual treatment. In patients from the trimetazidine group, an increase of LVEF was noted (from 38±5.5% to 47±7.1%, p=0.020). The increase of LVEF in the trimetazidine group was associated with a significant reduction of the LVESD comparing with the placebo group at 6 months follow-up. In comparison, the NT-pro BNP levels decreased significantly in the trimetazidine group (3.11±0.47 at baseline and 2.77±0.45 at 6 months follow-up, respectively, P<0.01) and the 6MT increased significantly in the trimetazidine group (325±44 m at baseline and 419±56 m at 6 months follow-up, respectively, P<0.01). The difference of NT-pro BNP levels and 6MT between the two groups were significant at 6 months follow-up (p=0.036, p=0.032).
Trimetazidine can improve LV function in chronic HF caused by LBBB and DCM. The positive effects of trimetazidine on LV function were especially evident in patients with optimization of HF drug therapy, which strongly suggested an additive effect of these modalities of therapy.