Effects of trimetazidine on left ventricular function in patients with type 2 diabetes and heart failure

Congestive heart failure and type 2 diabetes have a deleterious prognosis when combined. Trimetazidine, a metabolic agent with anti-ischemic properties, reduces fatty acid beta-oxidation via decreased 3-ketoacyl-coenzyme-A thiolase activity thereby facilitating energy production via the glycolytic pathway. Objectives: To assess myocardial function by Tissue Doppler Imaging (TDI) after one month of trimetazidine (Vastarel(R)) added on conventional treatment in patients with type 2 diabetes and heart failure. Methods: Twenty diabetic patients with ischemic heart failure (mean age 66 years; NYHA class II-III) were randomized to trimetazidine (60 mg daily) or placebo in a double-blind crossover design. Exercise tolerance, 2-dimensional echocardiograms, and TDI (rest and exercise) were studied before and during treatment. Results: Changes in exercise tolerance did not differ in the two groups. Ejection fraction at rest and moderate exercise only improved significantly with trimetazidine when analyzed for the first treatment period. TDI velocities did not change significantly during treatment periods. Conclusion: In this early pilot investigation of the effects of trimetazidine in patients with diabetes and heart failure there were only weak signs of improved systolic myocardial function at rest and exercise. The present observations indicate the need of further research to explore the effect of trimetazidine during longer treatment period or with more selected patient population.