title: A randomized clinical trial of trimetazidine, a partial free fatty acid oxidation inhibitor, in patients with heart failure.
abstract: OBJECTIVE
  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.
authors.affiliation: Clinical Cardiology-Heart Failure Unit, Istituto Scientifico-Universita Vita/Salute San Raffaele, Milan, Italy. gabriele.fragasso@hsr.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Fragasso
authors.forename: Altin
authors.initials: A
authors.lastname: Palloshi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Puccetti
authors.forename: Carmen
authors.initials: C
authors.lastname: Silipigni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rossodivita
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Pala
authors.forename: Giliola
authors.initials: G
authors.lastname: Calori
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000188:drug therapy*; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D016896:Treatment Outcome; D014292:Trimetazidine / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*; D016277:Ventricular Function, Left
chemical_list: D014665:Vasodilator Agents; D014292:Trimetazidine