Key result
Trimetazidine added to optimal medical therapy in heart failure patients significantly reduced maximum P-wave duration (from 106.7 to 102.2 ms, P=0.006) and P-wave dispersion (P<0.001).
Why the study?
Does trimetazidine improve P-wave duration and dispersion in heart failure patients on optimal medical therapy?
Does trimetazidine improve P-wave duration and dispersion in heart failure patients on optimal medical therapy?
p-value: p=<0.001
Trimetazidine added to optimal medical therapy in heart failure patients significantly improves P-wave duration and dispersion, which may have implications for preventing atrial fibrillation.
May support atrial conduction benefits in HF; hypothesis-generating for AF prevention, needs RCTs before practice change.
BACKGROUND: P-wave duration and dispersion (PWD) have been shown to be noninvasive predictors for development of atrial fibrillation. Thus, it may be possible to attenuate atrial fibrillation risk through normalization of P-wave duration and dispersion. Trimetazidine, a metabolic modulator, has been reported to improve cardiac function in heart failure (HF) patients. METHODS: Thirty-six HF patients being treated with angiotensin inhibitors, carvedilol, spironolactone, and furosemide were prescribed trimetazidine, 20 mg three times a day. Electrocardiographic and echocardiographic examinations were obtained before and 6 months after addition of trimetazidine in HF patients and 36 healthy control group patients having normal echocardiographic examination. RESULTS: Maximum P-wave duration (Pmax) (106.7 +/- 15.8 vs. 91.7 +/- 12.7 ms) and PWD (57.2 +/- 15.4 vs. 37.9 +/- 16.7 ms) were significantly longer in HF patients compared to the control group. There were significant correlations of Pmax and PWD with left atrial diameter (r = 0.508, P = < 0.001 and r = 0.315, P = 0.029), left ventricular ejection fraction (LVEF) (r = 0.401, p = 0.005 and r = 0.396, P = 0.005), deceleration time (r = 0.296, P = 0.032 and r = 0.312, P = 0.035), and isovolumetric relaxation time (r = 0.265, P = 0.038 and r = 0.322, P = 0.015). There were significant improvements in LVEF (32.7 +/- 6.5% to 37.2 +/- 5.5%, P = 0.036), left atrial diameter (41.5 +/- 6.7 to 40.3 +/- 6.1 mm, P < 0.001), and Pmax (106.7 +/- 15.8 to 102.2 +/- 11.5 ms, P = 0.006) and PWD (57.2 +/- 15.4 to 48.9 +/- 10.1 ms, P < 0.001) during follow-up. CONCLUSIONS: Trimetazidine added to optimal medical therapy in HF may improve Pmax and PWD in association with improved left ventricular function. Longer-term and larger studies are necessary to evaluate whether these findings may have clinical implications on prevention of atrial fibrillation.
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Güneş et al. (2009) studied Heart failure (n=72). Trimetazidine vs. Healthy control group (baseline) and pre-treatment values was evaluated on Maximum P-wave duration (Pmax) and P-wave dispersion (PWD) (p=<0.001). Trimetazidine added to optimal medical therapy in heart failure patients significantly reduced maximum P-wave duration (from 106.7 to 102.2 ms, P=0.006) and P-wave dispersion (P<0.001).