Beneficial effects of trimetazidine treatment on exercise tolerance and B-type natriuretic peptide and troponin T plasma levels in patients with stable ischemic cardiomyopathy

Background In patients with ischemic cardiomyopathy, mortality rate and quality of life are unsatisfactory. We investigated the effects of the metabolic agent trimetazidine (TMZ) on exercise tolerance and prognostic markers B-type natriuretic peptide (BNP) and cardiac troponin T (cTnT) plasma levels. Methods Fifty patients with ischemic cardiomyopathy were randomized either to receive TMZ (20 mg, TID) in addition to their conventional treatment (TMZ group, n = 25) or to continue their usual drug therapy (control group, n = 25) for 6 months. Patients were evaluated at baseline, at I month, and at 6 months (echocardiography and 6-minute walking test). At enrollment and at the end of follow-up, blood testing was performed for determination of BNP and cTnT plasma levels. Results After 6 months, no significant New York Heart Association class changes occurred in all patients (P = NS). In the TMZ group, a significant increase of exercise tolerance (P <.0 1) was detected, whereas left ventricular ejection fraction was unchanged (28% 4%, 29% 5%, and 32% 5% at baseline, at I month, and at 6 months, respectively; P = NS). In the TMZ group, BNP was significantly reduced (6 months, 135 22 vs 252 44 pg/mL; P <.001), whereas it was significantly increased in controls (6 months, 288 46 vs 239 59 pg/mL; P <.02); cTnT significantly (P <.00 1) reduced during TMZ treatment, whereas it was unchanged in the control group. Conclusions Six-month TMZ treatment improves exercise tolerance and reduces plasma levels of BNP and cTnT in patients with compensated ischemic cardiomyopathy.