Trimetazidine added to conventional therapy in heart failure patients significantly improved NYHA functional class (p<0.0001) and increased ejection fraction from 36% to 43% (p=0.002).
RCT (n=55)
Open-label
randomly allocated
Does the addition of trimetazidine to conventional therapy improve functional class and left ventricular function in patients with heart failure?
The long-term addition of trimetazidine to standard heart failure therapy significantly improves left ventricular ejection fraction and functional class.
Absolute Event Rate: 43% vs 34%
p-value: p=0.002
OBJECTIVES: This study sought to assess whether the long-term addition of trimetazidine to conventional treatment could improve functional class, exercise tolerance, and left ventricular function in patients with heart failure (HF). BACKGROUND: Previous small studies have shown that trimetazidine may be beneficial in terms of left ventricular function preservation and control of symptoms in patients with post-ischemic HF. METHODS: Fifty-five patients with HF were randomly allocated in an open-label fashion to either conventional therapy plus trimetazidine (20 mg three times daily) (28 patients) or conventional therapy alone (27 patients). Mean follow-up was 13 +/- 3 months. At study entry and at follow-up, all patients underwent exercise testing and two-dimensional echocardiography. Among the others, New York Heart Association (NYHA) functional class and ejection fraction (EF) were evaluated. RESULTS: In the trimetazidine group, NYHA functional class significantly improved compared with the conventional therapy group (p < 0.0001). Treatment with trimetazidine significantly decreased left ventricular end-systolic volume (from 98 +/- 36 ml to 81 +/- 27 ml, p = 0.04) and increased EF from 36 +/- 7% to 43 +/- 10% (p = 0.002). On the contrary, in the conventional therapy group, both left ventricular end-diastolic and -systolic volumes increased from 142 +/- 43 ml to 156 +/- 63 ml, p = 0.2, and from 86 +/- 34 ml to 104 +/- 52 ml, p = 0.1, respectively; accordingly, EF significantly decreased from 38 +/- 7% to 34 +/- 7% (p = 0.02). CONCLUSIONS: In conclusion, long-term trimetazidine improves functional class and left ventricular function in patients with HF. This benefit contrasts with the natural history of the disease, as shown by the decrease of EF in patients on standard HF therapy alone.
“Current evidence supports the potential role of trimetazidine in HFrEF, but this is based on multiple smaller trials of varying quality in study design. We recommend a large pragmatic randomised clinical trial to establish the definitive role of trimetazidine in the management of HFrEF.”
Fragasso et al. (2006) conducted an RCT in Heart failure (HF) (n=55). Trimetazidine vs. Conventional therapy alone was evaluated on Ejection fraction (EF) (p=0.002). Trimetazidine added to conventional therapy in heart failure patients significantly improved NYHA functional class (p<0.0001) and increased ejection fraction from 36% to 43% (p=0.002).