title: Trimetazidine and reduction in mortality and hospitalization in patients with ischemic dilated cardiomyopathy: a post hoc analysis of the Villa Pini d'Abruzzo Trimetazidine Trial.
abstract: The goal of this study was to determine the effects of trimetazidine on all-cause mortality and heart failure hospitalizations in patients with ischemic cardiomyopathy. We performed an extension to 48 months and a post-hoc analysis of the Villa Pini d'Abruzzo trimetazidine trial; in this single-center, open-label, randomized trial with the metabolic inhibitor trimetazidine in chronic heart failure, 61 patients were randomized to either receive trimetazidine (20 mg tid) in addition to their conventional treatment or to continue their usual drug therapy for 4 years. Patients were evaluated at baseline and at 6, 12, 18, 24, 32, 36, 42, and 48 months with clinical examination, echocardiography, and 6-minute walking test. Trimetazidine added to usual treatment significantly reduces all-cause mortality (-56%; hazard ratio, 0.258; 95% CI, 0.097 to 0.687; log-rank test, P = 0.0047), heart failure hospitalization (-47%; log-rank test, P = 0.002), and improves patient functional status (NYHA class and 6-min walking test). In trimetazidine-treated patients, a significant increase of the left ventricle ejection fraction was also detected (LVEF P < 0.001 at 48 months). It is therefore concluded that long-term trimetazidine significantly reduces all-cause mortality and heart failure hospitalization in patients with ischemic cardiomyopathy. If confirmed in large-scale randomized trials, this treatment could be useful in the management of left ventricle dysfunction and remodeling in patients with ischemic heart disease.
authors.affiliation: Centre for Study and Treatment of Congestive Heart Failure, Department of Cardiology, Casa di Cura Villa Pini d'Abruzzo, Chieti, Italy. dinapoli@unich.it
authors.forename: Pericle
authors.initials: P
authors.lastname: Di  Napoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Di  Giovanni
authors.forename: Marta Assunta
authors.initials: MA
authors.lastname: Gaeta
authors.forename: Alfonso A
authors.initials: AA
authors.lastname: Taccardi
authors.forename: Antonio
authors.initials: A
authors.lastname: Barsotti
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D013318:Stroke Volume / Q000187:drug effects; D015996:Survival Rate; D016896:Treatment Outcome; D014292:Trimetazidine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects; D016138:Walking / Q000502:physiology
chemical_list: D014665:Vasodilator Agents; D002097:C-Reactive Protein; D014292:Trimetazidine