title: Metabolic manipulation in dilated cardiomyopathy: Assessing the role of trimetazidine.
abstract: OBJECTIVE
  To study the role of metabolic modulator (trimetazidine: TMZ) in dilated cardiomyopathy (DCM). Optimizing altered substrate metabolism in heart failure (HF) with metabolic modulators allows more efficacious energy production from glucose than from free fatty acids.
  
  
  METHODS
  100 patients of DCM (47.7 years, NYHA class 2.17, LVEF 27.3%) were randomized to TMZ (20mg tid, n=50) vs conventional therapy (n=50). Functional status, BNP and various echocardiographic parameters were assessed at 3-6 months.
  
  
  RESULTS
  At 3 months, TMZ group had significantly improved NYHA class (2.25 vs 1.85), 6min walk test (349.7 vs 402m), LVD-36 score (25.5 vs 21) and BNP (744.7 vs 248.3pg/ml), all p 0.001. Significant improvement was also seen in LV end-systolic (LVESV, 87.1±27.5 vs 78.5±24.9ml/m2, p 0.001), LV end-diastolic volumes (LVEDV, 117.6±29.3 vs 110.9±27.4ml/m2, p 0.001), LVEF (27 vs 30.9%, p 0.001) and LV wall stress (90.2±18.9 vs 71.1±13.2dyn/cm2, p 0.0001). The % change in LVESV, LVEDV, LVEF and LV wall stress was -9.5%, -5.4%, +8.4% and -21.8%. Other echo parameters also improved after 3 months of TMZ (E/A ratio 1.9 vs 1.2, p=0.001, E/A VTI 2.7 vs 1.6, p=0.001, myocardial performance index, MPI 0.8 vs 0.7, p=0.0001), Tissue Doppler parameters (E/E' septal (19.7 vs 12.5, p=0.001) and E/E' lateral (13.3 vs 9.4, p=0.0001)). Patients in control group had no change in NYHA class, LVD-36 scores, LV volumes or LVEF at 3 months although BNP and LV wall stress reduced to a slight extent. Patients on TMZ had further improvement in NYHA class, walk test, BNP levels and echocardiographic parameters at 6 months.
  
  
  CONCLUSIONS
  Metabolic modulators (TMZ) may help in improving LV function in DCM. In this study, benefit was noted by 3 months with further improvement at 6 months.
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Jatain
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India. Electronic address: akapoor65@gmail.com.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
authors.forename: Roopali
authors.initials: R
authors.lastname: Khanna
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Garg
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
authors.forename: Satyendra
authors.initials: S
authors.lastname: Tewari
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
authors.forename: Pravin
authors.initials: P
authors.lastname: Goel
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D004734:Energy Metabolism / Q000187:drug effects*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014292:Trimetazidine / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D014292:Trimetazidine
keywords: Dilated cardiomyopathy; Heart failure; Metabolic modulation; Trimetazidine