title: Effects of trimetazidine in nonischemic heart failure: a randomized study.
abstract: OBJECTIVE
  Heart failure (HF) is associated with changes in myocardial metabolism that lead to impairment of contractile function. Trimetazidine (TMZ) modulates cardiac energetic efficiency and improves outcomes in ischemic heart disease. We evaluated the effects of TMZ on left ventricular ejection fraction (LVEF), cardiac metabolism, exercise capacity, O2 uptake, and quality of life in patients with nonischemic HF.
  
  
  RESULTS
  Sixty patients with stable nonischemic HF under optimal medical therapy were included in this randomized double-blind study. Patients were randomized to TMZ (35 mg orally twice a day) or placebo for 6 months. LVEF, 6-minute walk test (6MWT), maximum O2 uptake in cardiopulmonary exercise test, different markers of metabolism, oxidative stress, and endothelial function, and quality of life were assessed at baseline and after TMZ treatment. Left ventricular peak glucose uptake was evaluated with the use of the maximum standardized uptake value (SUV) by 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET). Etiology was idiopathic in 85% and hypertensive in 15%. Both groups were similar in age, functional class, LVEF, and levels of N-terminal pro-B-type natriuretic peptide at baseline. After 6 months of TMZ treatment, no changes were observed in LVEF (31 ± 10% vs 34 ± 8%; P = .8), 6MWT (443 ± 25 m vs 506 ± 79 m; P = .03), maximum O2 uptake (19.1 ± 5.0 mL kg(-1) min(-1) vs 23.0 ± 7.2 mL kg(-1) min(-1); P = .11), functional class (percentages of patients in functional classes I/II/III/IV 10/3753/0 vs 7/40/50/3; P = .14), or quality of life (32 ± 26 points vs 24 ± 18 points; P = .25) in TMZ versus placebo, respectively. In the subgroup of patients evaluated with (18)FDG-PET, no significant differences were observed in SUV between both groups (7.0 ± 3.6 vs 8.2 ± 3.4 respectively; P = .47).
  
  
  CONCLUSIONS
  In patients with nonischemic HF, the addition of TMZ to optimal medical treatment does not result in significant changes of LVEF, exercise capacity, O2 uptake, or quality of life.
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; División de Enfermedades Cardiovasculares and Departamento de Medicina Nuclear, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Winter
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; División de Enfermedades Cardiovasculares and Departamento de Medicina Nuclear, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: pcastro@med.puc.cl.
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Castro
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; División de Enfermedades Cardiovasculares and Departamento de Medicina Nuclear, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Quintana
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; División de Enfermedades Cardiovasculares and Departamento de Medicina Nuclear, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Altamirano
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; División de Enfermedades Cardiovasculares and Departamento de Medicina Nuclear, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Andres
authors.initials: A
authors.lastname: Enriquez
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; División de Enfermedades Cardiovasculares and Departamento de Medicina Nuclear, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Verdejo
authors.affiliation: División de Enfermedades Cardiovasculares and Departamento de Medicina Nuclear, Facultad Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Jalil
authors.affiliation: Facultad Química, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Mellado
authors.affiliation: Hospital Dipreca, Santiago, Chile.
authors.forename: Roberto
authors.initials: R
authors.lastname: Concepción
authors.affiliation: Hospital San Juan de Dios, Facultad Medicina, Santiago, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Sepúlveda
authors.affiliation: Hospital Salvador, Facultad Medicina, Santiago, Chile.
authors.forename: Victor
authors.initials: V
authors.lastname: Rossel
authors.affiliation: Hospital Clínico, Facultad Medicina, Santiago, Chile.
authors.forename: Luis
authors.initials: L
authors.lastname: Sepúlveda
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; Centro Estudios Moleculares de la Célula, Facultad Ciencias Químicas y Farmacéuticas and Facultad Medicina, Universidad de Chile, Santiago, Chile.
authors.forename: Mario
authors.initials: M
authors.lastname: Chiong
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; Centro Estudios Moleculares de la Célula, Facultad Ciencias Químicas y Farmacéuticas and Facultad Medicina, Universidad de Chile, Santiago, Chile.
authors.forename: Lorena
authors.initials: L
authors.lastname: García
authors.affiliation: Advanced Center for Chonic Diseases, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile; Centro Estudios Moleculares de la Célula, Facultad Ciencias Químicas y Farmacéuticas and Facultad Medicina, Universidad de Chile, Santiago, Chile; Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Sergio
authors.initials: S
authors.lastname: Lavandero
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D011446:Prospective Studies; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D014292:Trimetazidine / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D014292:Trimetazidine
keywords: Trimetazidine; cardiac metabolism; heart failure