title: Trimetazidine improves exercise tolerance in patients with ischemic heart disease : A meta-analysis.
abstract: OBJECTIVE
  This study aimed to evaluate the effect of trimetazidine (TMZ) in addition to standard treatment on exercise tolerance in patients with ischemic heart disease (IHD).
  
  
  METHODS
  Studies were identified via a systematic search of PubMed, Embase, Cochrane Library, and the Chinese CNKI databases from January 1978 to January 2015. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Random or fixed effects models were used to estimate pooled mean differences in total exercise duration (TED), peak oxygen uptake (pVO2), metabolic equivalent system (METS), and 6-minute walking test (6-MWT).
  
  
  RESULTS
  In all, 16 randomized controlled trials (RCTs) consisting of 2,004 participants were included. Pooled results showed that TMZ treatment significantly improved TED (WMD: 37.35, 95 % CI: 25.58-49.13, p < 0.00001), pVO2 (WMD: 2.41, 95 % CI: 1.76-3.06, p < 0.00001), METS (WMD: 1.33, 95 % CI: 0.38-2.28, p = 0.006), and 6-WMT (WMD: 62.46, 95 % CI: 35.86-89.05, p < 0.001) in all patients with IHD. Subgroup analysis showed that TMZ significantly increased TED in nondiabetic participants (WMD 34.77, 95 % CI: 22.28-47.25, p < 0.001), but not in diabetic participants (WMD: 40.36, 95 % CI: - 18.76-99.48, p = 0.18). And, subgroup analysis of TED by intervention duration suggested that there is no statistically difference between the 3-month and 6-month periods (WMD: 35.47, 95 %CI: 18.35-52.60, p < 0.0001 and WMD: 49.94, 95 %CI: 44.69-55.19, p < 0.00001). In addition, TMZ improved TED (WMD: 50.01, 95 % CI: 44.77-55.25 and WMD: 24.20, 95 % CI: 12.72-35.68) in IHD patients with or without heart failure (HF), respectively.
  
  
  CONCLUSIONS
  Addition of TMZ to standard treatment significantly improved exercise tolerance in patients with IHD, and IHD patients with HF may experience even more benefits. However, there is insufficient evidence to show that TMZ has beneficial effects in participants with diabetes.
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China.
authors.forename: L
authors.initials: L
authors.lastname: Peng
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China.
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China.
authors.forename: R
authors.initials: R
authors.lastname: Dong
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Tian-he Road, 510630, Guangzhou, China. liujlgz@yeah.net.
authors.forename: J
authors.initials: J
authors.lastname: Liu
mesh_terms: D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D005080:Exercise Test / Q000187:drug effects* / Q000706:statistics & numerical data*; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D014292:Trimetazidine / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D014292:Trimetazidine
keywords: Chronic heart failure; Exercise tolerance; Ischemic heart disease; Meta-analysis; Trimetazidine