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Advances in Therapy

, 26:455 | Cite as

Effect of trimetazidine on quality of life in elderly patients with ischemic dilated cardiomyopathy

  • Giuseppe MarazziEmail author
  • Otavio Gebara
  • Cristiana Vitale
  • Giuseppe Caminiti
  • Mauricio Wajngarten
  • Maurizio Volterrani
  • José A. F. Ramires
  • Giuseppe Rosano
  • Massimo Fini
Review

Abstract

Introduction

Elderly patients have an increased incidence of ischemic dilated cardiomyopathy, often related to diffuse coronary artery disease. Data have been cumulated to suggest that trimetazidine improves myocardial ischemia in patients with ischemic heart disease and improves left ventricular function in elderly patients with ischemic cardiomyopathy. The purpose of the present study was to assess the effects of trimetazidine in addition to standard cardiovascular therapy on left ventricular function and quality of life (QOL) parameters in elderly patients with ischemic heart disease and reduced left ventricular function.

Methods

Patients were randomized to receive either trimetazidine (twice daily) or placebo (twice daily) in addition to standard therapy, and were evaluated at baseline and after 6 months.

Results

Forty-seven patients completed the study (40 male, seven female; mean [±SD] age 78±3.4 years). Demographic data were comparable between the two groups with respect to sex, age, and race. At 6 months there was a significant improvement in the number of angina episodes per week in the trimetazidine group (−2.3±1, P=0.023). The overall assessment of QOL by a visual analog scale showed an improvement in patients randomized to trimetazidine at 6 months (from 4.1±0.6 to 6.4±0.8, P<0.01) and no changes in patients randomized to placebo (from 4.3±0.7 to 4.2±0.9, P>0.05). Physical QOL, evaluated by a MacNew Quality of Life After Myocardial Infarction questionnaire (MacNewQLMI), improved in patients randomized to trimetazidine but not in those allocated to placebo (32%±5% vs. −1%±3%, P<0.01). Similar results were obtained on social QOL evaluated by MacNewQLMI with trimetazidine compared with placebo (39%±4% vs. −2%±5%, P<0.01).

Conclusion

In elderly patients with ischemic heart disease and reduced ventricular function, trimetazidine improves clinical condition and QOL.

Keywords

angina ischemia quality of life trimetazidine 

References

  1. 1.
    Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104:46–53.Google Scholar
  2. 2.
    Harpaz D, Rozenman Y, Behar S, et al. Coronary angiography in the elderly with acute myocardial infarction. Int J Cardiol. 2007;116:249–256.PubMedCrossRefGoogle Scholar
  3. 3.
    Czernin J, Muller P, Chan S, et al. Influence of age and hemodynamics on myocardial blood flow and flow reserve. Circulation. 1993;88:62–69.PubMedGoogle Scholar
  4. 4.
    Cohn PF. Silent myocardial ischemia: dimensions of the problem in patients with and without angina. Am J Med. 1986;80(suppl. 4C):3–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Rosano GM, Fini M, Caminiti G, Barbaro G. Cardiac metabolism in myocardial ischemia. Curr Pharm Des. 2008;14:2551–2562.PubMedCrossRefGoogle Scholar
  6. 6.
    Stanley WC. Cardiac energetics during ischaemia and the rationale for metabolic interventions. Coron Artery Dis. 2001;12(suppl. 1):S3–S7.PubMedGoogle Scholar
  7. 7.
    Kantor PF, Lucien A, Kozak R, et al. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial longchain 3-ketoacyl coenzyme A thiolase. Circ Res. 2000;86:580–588.PubMedGoogle Scholar
  8. 8.
    Lavanchy N, Martin J, Rossi A. Anti-ischemia effects of trimetazidine: 31P-NMR spectroscopy in the isolated rat heart. Arch Int Pharmacodyn Ther. 1987;286:97–110.PubMedGoogle Scholar
  9. 9.
    Lopaschuk GD. Optimizing cardiac energy metabolism: how can fatty acid and carbohydrate metabolism be manipulated? Coron Artery Dis. 2001;12(suppl. 1):S8–S11.PubMedGoogle Scholar
  10. 10.
    Vitale C, Wajngaten M, Sposato B, et al. Trimetazidine improves left ventricular function and quality of life in elderly patients with coronary artery disease. Eur Heart J. 2004;25:1814–1821.PubMedCrossRefGoogle Scholar
  11. 11.
    Belardinelli R, Purcaro A. Effects of trimetazidine on the contractile response of chronically dysfunctional myocardium to low-dose dobutamine in ischaemic cardiomyopathy. Eur Heart J. 2001;22:2164–2170.PubMedCrossRefGoogle Scholar
  12. 12.
    Fragasso G, Palloshi A, Puccetti P, et al. A randomized clinical trial of trimetazidine, a partial free fatty acid oxidation inhibitor, in patients with heart failure. J Am Coll Cardiol. 2006;48:992–998.PubMedCrossRefGoogle Scholar
  13. 13.
    Campeau L. Grading of angina pectoris [Letter]. Circulation. 1976;54:522–523.PubMedGoogle Scholar
  14. 14.
    Höfer S, Lim L, Guyatt G, Oldridge N. The MacNew Heart Disease health-related quality of life instrument: a summary. Health Qual Life Outcomes. 2004;2:3.PubMedCrossRefGoogle Scholar
  15. 15.
    McConnell TR, Laubach CA, Memon M, Gardner JK, Klinger TA, Palm RJ. Quality of life and self efficacy in cardiac rehabilitation patients over 70 years of age following acute myocardial infarction and bypass revascularization surgery. Am J Geriatr Cardiol. 2000;9:210–218.PubMedCrossRefGoogle Scholar
  16. 16.
    Oldridge N, Gottlieb M, Guyatt G, Jones N, Streiner D, Feeny D. Predictors of health-related quality of life with cardiac rehabilitation after acute myocardial infarction. J Cardiopulm Rehabil. 1998;18:95–103.PubMedCrossRefGoogle Scholar
  17. 17.
    Hofer S, Benzer W, Schussler G, von Steinbuchel N, Oldridge NB. Health-related quality of life in patients with coronary artery disease treated for angina: validity and reliability of German translations of two specific questionnaires. Qual Life Res. 2003;12:199–212.PubMedCrossRefGoogle Scholar
  18. 18.
    Hillers TK, Guyatt GH, Oldridge N, et al. Quality of life after myocardial infarction. J Clin Epidemiol. 1994;47:1287–1296.PubMedCrossRefGoogle Scholar
  19. 19.
    Rosano GM, Vitale C, Sposato B, Mercuro G, Fini M. Trimetazidine improves left ventricular function in diabetic patients with coronary artery disease: a double-blind placebo-controlled study. Cardiovasc Diabetol. 2003;2:16.PubMedCrossRefGoogle Scholar
  20. 20.
    Monti LD, Setola E, Fragasso G, et al. Metabolic and endothelial effects of trimetazidine on forearm skeletal muscle in patients with type 2 diabetes and ischemic cardiomyopathy. Am J Physiol Endocrinol Metab. 2006;290:E54–E59.PubMedCrossRefGoogle Scholar
  21. 21.
    Andrews R, Walsh JT, Evans A, Curtis S, Cowley AJ. Abnormalities of skeletal muscle metabolism in patients with chronic heart failure: evidence that they are present at rest. Heart. 1997;77:159–163.PubMedGoogle Scholar
  22. 22.
    Emre M, Karayaylali I, San M, Demirkazik A, Kavak S. The acute effect of trimetazidine on the high frequency fatigue in the isolated rat diaphragm muscle. Arch Pharm Res. 2004;27:646–652PubMedCrossRefGoogle Scholar

Copyright information

© Springer Healthcare Communications 2009

Authors and Affiliations

  • Giuseppe Marazzi
    • 1
    Email author
  • Otavio Gebara
    • 2
  • Cristiana Vitale
    • 1
  • Giuseppe Caminiti
    • 1
  • Mauricio Wajngarten
    • 2
  • Maurizio Volterrani
    • 1
  • José A. F. Ramires
    • 2
  • Giuseppe Rosano
    • 1
  • Massimo Fini
    • 1
  1. 1.Department of Medical SciencesCenter for Clinical and Basic ResearchRomaItaly
  2. 2.Cardiogeriatric Unit, INCORSao PauloBrazil

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