title: Combination Therapy With Coenzyme Q10 and Trimetazidine in Patients With Acute Viral Myocarditis.
abstract: BACKGROUND
  Acute viral myocarditis is an inflammatory disease with global impact. Although it may resolve spontaneously, its course is not easily predicted, and there is a paucity of specific treatment options available with proven efficacy. Coenzyme Q10 (CQ10) and trimetazidine possess antioxidant and antiinflammatory effects.
  
  
  METHODS
  We examined the therapeutic efficacy of these agents in acute viral myocarditis both individually and in combination. Patients were blinded and randomized to receive CQ10 (n = 42), trimetazidine (n = 39), or CQ10 + trimetazidine (n = 43) treatment.
  
  
  RESULTS
  Serum inflammatory and oxidative stress marker and myocardial enzyme levels, and heart function were measured. Both CQ10 and trimetazidine decreased inflammatory and oxidative stress biomarker levels compared with baseline measurements. However, combination therapy with CQ10 and trimetazidine showed a significantly more powerful effect not only on markers of inflammation and oxidative stress, but also on left ventricular systolic function and troponin, compared with either treatment alone.
  
  
  CONCLUSIONS
  This study confirmed the beneficial effect of CQ10 and trimetazidine individually, but demonstrated a superior effect of combining the therapies on cardiac left ventricular ejection fraction, and biochemical markers of myocardial damage in acute viral myocarditis.
authors.affiliation: *Department of Cardiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; †Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; ‡Oxidative Signaling Laboratory, North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; and §Department of Geriatrics & Neurology, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Shao
authors.forename: Aiqun
authors.initials: A
authors.lastname: Ma
authors.forename: Gemma
authors.initials: G
authors.lastname: Figtree
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002681:China; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D009205:Myocarditis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D018384:Oxidative Stress / Q000187:drug effects; D020127:Recovery of Function; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014292:Trimetazidine / Q000009:adverse effects / Q000627:therapeutic use*; D014336:Troponin / Q000097:blood; D014451:Ubiquinone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D015415:Biomarkers; D018836:Inflammation Mediators; D014336:Troponin; D014451:Ubiquinone; C024989:coenzyme Q10; D014292:Trimetazidine