title: Effect of partial inhibition of fatty acid oxidation by trimetazidine on whole body energy metabolism in patients with chronic heart failure.
abstract: OBJECTIVE
  Trimetazidine may have beneficial effects on left ventricular (LV) function in patients with systolic heart failure. The authors assessed whether long-term addition of trimetazidine to conventional treatment could improve, along with LV function, resting whole body energy metabolism in patients with chronic systolic heart failure.
  
  
  METHODS
  Single blind randomised study.
  
  
  METHODS
  University Hospital.
  
  
  METHODS
  44 patients with systolic heart failure receiving full medical treatment.
  
  
  METHODS
  Indirect calorimetry and two-dimensional echocardiography at baseline and after 3 months.
  
  
  METHODS
  Whole body resting energy expenditure (REE), percentage of predicted REE, LV ejection fraction (EF), NYHA class, quality of life.
  
  
  RESULTS
  Trimetazidine increased EF compared with conventional therapy alone (from 35±8% to 42±11% vs from 35±7% to 36±6%; p=0.02, analysis of variance for repeated measures). NYHA class and quality of life also improved compared with conventional therapy (p<0.0001). REE (from 1677±264 to 1580±263 kcal/day) and percentage of predicted REE (based on the Harris-Benedict equation: from 114±10% to 108±9%) decreased in the trimetazidine group, but not in the control group (REE from 1679±304 to 1690±337 kcal/day and percentage of predicted REE from 113±12% to 115±14%). The variation was different between groups (p=0.03 and 0.023, respectively).
  
  
  CONCLUSIONS
  In patients with systolic heart failure, improvement in functional class and LV function induced by middle-term trimetazidine therapy is paralleled by a reduction in whole body REE. The beneficial cardiac effects of trimetazidine may be also mediated by a peripheral metabolic effect.
authors.affiliation: Division of Metabolic and Cardiovascular Sciences, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy. gabriele.fragasso@hsr.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Fragasso
authors.forename: Anna
authors.initials: A
authors.lastname: Salerno
authors.forename: Guido
authors.initials: G
authors.lastname: Lattuada
authors.forename: Amarild
authors.initials: A
authors.lastname: Cuko
authors.forename: Giliola
authors.initials: G
authors.lastname: Calori
authors.forename: Antonella
authors.initials: A
authors.lastname: Scollo
authors.forename: Francesca
authors.initials: F
authors.lastname: Ragogna
authors.forename: Francesco
authors.initials: F
authors.lastname: Arioli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bassanelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Spoladore
authors.forename: Livio
authors.initials: L
authors.lastname: Luzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
authors.forename: Gianluca
authors.initials: G
authors.lastname: Perseghin
mesh_terms: D000368:Aged; D002151:Calorimetry; D002908:Chronic Disease; D004452:Echocardiography; D004734:Energy Metabolism / Q000187:drug effects*; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D008297:Male; D010084:Oxidation-Reduction / Q000187:drug effects; D013318:Stroke Volume; D014292:Trimetazidine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D005227:Fatty Acids; D014665:Vasodilator Agents; D014292:Trimetazidine