Document Detail


Effects of trimetazidine on myocardial perfusion and the contractile response of chronically dysfunctional myocardium in ischemic cardiomyopathy: a 24-month study.
MedLine Citation:
PMID:  15984909     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim was to assess the long-term effect of trimetazidine on myocardial perfusion, using gated single photon emission computerized tomography (SPECT). METHODS: 200 patients (aged 54.7 +/- 12 years) with ischemic left ventricular dysfunction (LVD) and multivessel coronary artery disease were randomized to receive trimetazidine 20mg three times daily or a placebo for 24 months. At baseline and after 24 months of treatment, all patients underwent a symptom-limited cardiopulmonary exercise test concluded by the injection of (99m)Tc-MIBI (technetium-99m methoxy-isobutyl-isonitrile). Imaging of post-stress gated SPECT and resting gated SPECT were performed. Standard antianginal therapy was interrupted for 48 hours (nitrates for 6 hours) before the exercise tests and resumed immediately after testing. RESULTS: On initial evaluation, summed stress and rest scores (SSS and SRS, respectively), systolic wall thickness (SWT), and wall motion score index (WMI), heart rate, SBP, and rate pressure product were similar at rest and peak exercise in both groups. After 24 months, 91% of patients in the trimetazidine group versus 22% in the placebo group showed a significant decrease of the frequency of anginal episodes per week (3.9 vs 5.7, p < 0.01). Weekly nitroglycerin (glyceryl trinitrate) tablet consumption was significantly lower with trimetazidine than with placebo at endpoint (2.3 +/- 0.8 vs 6.1 +/- 1.6, p < 0.01). This was supported by perfusion SPECT data. Compared with baseline values, SSS and SRS were significantly reduced with trimetazidine (from 19.8 +/- 7.7 to 11.2 +/- 6.1, p < 0.00001 and from 12.4 +/- 8.7 to 5.8 +/- 3.3, p < 0.00001, respectively). There was a nonsignificant decrease from baseline values in both SRS and SSS with placebo group (from 11.9 +/- 8.3 to 11.2 +/- 7.4 and 18.1 +/- 6.3 to 17.9 +/- 9.2, respectively). Duration of peak exercise increased significantly from baseline values with trimetazidine (from 4.6 to 5.8 minutes, p < 0.01) but not with placebo (from 5.4 to 5.8 minutes). Accordingly, mean maximum work at peak exercise improved by 1.2 metabolic equivalents with trimetazidine. This was proved by gated SPECT with an increase in SWT score of 89.5% (p < 0.00001) and in ejection fraction of 23% with trimetazidine (p < 0.001) without significant changes in hemodynamic parameters. CONCLUSION: Trimetazidine improves ischemic attacks in patients with ischemic cardiomyopathy, clinically and objectively as seen in gated SPECT myocardial perfusion. The improvement in myocardial function with trimetazidine was not accompanied by hemodynamic changes.
Authors:
Taher El-Kady; Khaled El-Sabban; Mohamed Gabaly; Ahmed Sabry; Sherif Abdel-Hady
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of cardiovascular drugs : drugs, devices, and other interventions     Volume:  5     ISSN:  1175-3277     ISO Abbreviation:  Am J Cardiovasc Drugs     Publication Date:  2005  
Date Detail:
Created Date:  2005-06-29     Completed Date:  2005-10-31     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  100967755     Medline TA:  Am J Cardiovasc Drugs     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  271-8     Citation Subset:  IM    
Affiliation:
Nuclear Cardiology Unit and Cardiology Department, Nuclear Cardiology Unit, National Heart Institute, Cairo University, Cairo, Egypt.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiomyopathies / drug therapy*,  physiopathology,  radionuclide imaging
Coronary Circulation / drug effects*
Echocardiography
Exercise Test
Female
Heart Function Tests
Hemodynamics / drug effects,  physiology
Humans
Male
Middle Aged
Myocardial Contraction / drug effects*
Myocardial Ischemia / drug therapy*,  physiopathology,  radionuclide imaging
Radiopharmaceuticals / diagnostic use
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon
Trimetazidine / adverse effects,  therapeutic use*
Vasodilator Agents / adverse effects,  therapeutic use*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Vasodilator Agents; 109581-73-9/Technetium Tc 99m Sestamibi; 5011-34-7/Trimetazidine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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