What is the clinical evidence from this study?

Study design: RCT. Population: Heart failure with reduced ejection fraction due to ischemic heart disease (n=25). Intervention: Trimetazidine vs. Placebo. Primary outcome: Change in left ventricular global longitudinal strain (LV GLS) (p=0.001).

August 23, 2022Open Access

Trimetazidine improves left ventricular global longitudinal strain value in patients with heart failure with reduced ejection fraction due to ischemic heart disease

RHRille Puspitoadhi HarjokoDr. Kariadi Hospital MSMochamad Ali SobirinDiponegoro University IUIlham UddinDiponegoro University

Key Result

Trimetazidine significantly improved left ventricular global longitudinal strain compared to placebo (change of 1.5% vs -0.7%, p=0.001) in patients with heart failure with reduced ejection fraction due to ischemic heart disease.

Study Design

Type

RCT (n=25)

Blinding

Double-blind

Randomization

Random sample generator application

Multicenter

Structured PICO

Does trimetazidine improve left ventricular global longitudinal strain in patients with HFrEF due to ischemic heart disease?

Population

25 patients with stable heart failure with reduced ejection fraction (LVEF 20-40%) due to ischemic heart disease, mean age 57.1 years, followed for 3 months.

Intervention

Modified-release trimetazidine 35 mg oral twice daily for 3 months (12 weeks), added to standard heart failure medication.

Comparator

Matching placebo oral twice daily for 3 months (12 weeks), added to standard heart failure medication.

Outcome

Change in left ventricular global longitudinal strain (LV GLS) value assessed using 2D speckle-tracking echocardiography at 3 months.surrogate

Trimetazidine added to standard medical therapy significantly improves left ventricular contractile function, as measured by global longitudinal strain, in patients with HFrEF due to ischemic heart disease.

Main Result

Absolute Event Rate: 1.5% vs -0.7%

p-value: p=0.001

Limitations

Assessed only the short-term effect (3 months) on echocardiographic parameters
Did not assess other clinical outcome parameters such as exercise capacity, major cardiovascular events, and heart failure hospitalization incidence
Most standard heart failure treatments of the subjects could not achieve the maximum recommended daily dose target guidelines

Abstract

Heart failure with reduced ejection fraction (HFrEF) due to ischemic heart disease (IHD) showed a progressive decline in left ventricular contractile function. However, no previous study has examined the left ventricular global longitudinal strain (LV GLS) parameter that represents LV contractile function. We investigated whether trimetazidine could improve the LV GLS value in patients with HFrEF due to IHD. We performed a double-blind, randomized controlled trial (RCT) including 26 patients with HFrEF due to stable IHD who were given modified-release trimetazidine 35 mg twice per day (n = 13) or placebo (n = 13) for 3 months in addition to standard medication. Left ventricular systolic function including GLS values was assessed at baseline and after 3 months using echocardiography. A total of 25 participants (13 control and 12 trimetazidine groups) were recruited with a baseline average age of 57.1 ± 10 years, and LV ejection fraction (LVEF) value of 34.6% ± 4.4%, and a GLS value of 7.4% ± 2.1%. Baseline clinical characteristics and echocardiogram were similar between the two groups. There was significant GLS improvement in the trimetazidine group (-6.9% ± 2.4% to -8.4% ± 2.6%, p = 0.000), but no significant differences were noted in the control group. The GLS improvement was significantly higher in the trimetazidine group than the control (1.5% + 0.9% vs. -0.7% + 1.7%, p = 0.001). No adverse drug reactions from the administration of trimetazidine in this study. Trimetazidine may improve GLS values in patients with HFrEF due to IHD.

Ask AI

Helpful

Bookmark

View Full Paper