Trimetazidine increased ejection fraction from 30.9% to 34.8% (P=0.027 vs placebo) and improved insulin sensitivity in nondiabetic patients with idiopathic dilated cardiomyopathy.
RCT (n=19)
Single-blind
Does trimetazidine improve cardiac function, perfusion, and metabolism in nondiabetic patients with idiopathic dilated cardiomyopathy?
In nondiabetic patients with idiopathic dilated cardiomyopathy, trimetazidine improves ejection fraction and whole-body insulin sensitivity, suggesting both cardiac and extracardiac metabolic benefits.
p-value: p=0.027
BACKGROUND: The anti-ischemic agent trimetazidine improves ejection fraction in heart failure that is hypothetically linked to inhibitory effects on cardiac free fatty acid (FFA) oxidation. However, FFA oxidation remains unmeasured in humans. We investigated the effects of trimetazidine on cardiac perfusion, efficiency of work, and FFA oxidation in idiopathic dilated cardiomyopathy. METHODS AND RESULTS: Nineteen nondiabetic patients with idiopathic dilated cardiomyopathy on standard medication were randomized to single-blind trimetazidine (n=12) or placebo (n=7) for 3 months. Myocardial perfusion, FFA, and total oxidative metabolism were measured using positron emission tomography with (15)OH(2)O, (11)Cacetate, and (11)Cpalmitate. Cardiac function was assessed echocardiographically; insulin sensitivity was assessed by the homeostasis model assessment index. Trimetazidine increased ejection fraction from 30.9+/-8.5% to 34.8+/-12% (P=0.027 versus placebo). Myocardial FFA uptake was unchanged, and beta-oxidation rate constant decreased only 10%. Myocardial perfusion, oxidative metabolism, and work efficiency remained unchanged. Trimetazidine decreased insulin resistance (glucose: 5.9+/-0.7 versus 5.5+/-0.6 mmol/L, P=0.047; insulin: 10+/-6.9 versus 7.6+/-3.6 mU/L, P=0.031; homeostasis model assessment index: 2.75+/-2.28 versus 1.89+/-1.06, P=0.027). The degree of beta-blockade and trimetazidine interacted positively on ejection fraction. Plasma high-density lipoprotein concentrations increased 11% (P<0.001). CONCLUSIONS: In idiopathic dilated cardiomyopathy with heart failure, trimetazidine increased cardiac function and had both cardiac and extracardiac metabolic effects. Cardiac FFA oxidation modestly decreased and myocardial oxidative rate was unchanged, implying increased oxidation of glucose. Trimetazidine improved whole-body insulin sensitivity and glucose control in these insulin-resistant idiopathic dilated cardiomyopathy patients, thus hypothetically countering the myocardial damage of insulin resistance. Additionally, the trimetazidine-induced increase in ejection fraction was associated with greater beta1-adrenoceptor occupancy, suggesting a synergistic mechanism.
Tuunanen et al. (Tue,) conducted a rct in Idiopathic dilated cardiomyopathy (n=19). Trimetazidine vs. Placebo was evaluated on Ejection fraction (p=0.027). Trimetazidine increased ejection fraction from 30.9% to 34.8% (P=0.027 vs placebo) and improved insulin sensitivity in nondiabetic patients with idiopathic dilated cardiomyopathy.
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