Is treatment with trimetazidine beneficial in patients with chronic heart failure?

Xiang Zhou,Jianchang Chen,Yiru Guo

doi:10.1371/journal.pone.0094660

Xiang Zhou, Jianchang Chen + Show 1 more

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https://doi.org/10.1371/journal.pone.0094660

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Abstract

BackgroundWhether additional benefit can be achieved with the use of trimetazidine (TMZ) in patients with chronic heart failure (CHF) remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of TMZ treatment in CHF patients.MethodsWe searched PubMed, EMBASE, and Cochrane databases through October 2013 and included 19 RCTs involving 994 CHF patients who underwent TMZ or placebo treatment. Risk ratio (RR) and weighted mean differences (WMD) were calculated using fixed or random effects models.ResultsTMZ therapy was associated with considerable improvement in left ventricular ejection fraction (WMD: 7.29%, 95% CI: 6.49 to 8.09, p<0.01) and New York Heart Association classification (WMD: −0.55, 95% CI: −0.81 to −0.28, p<0.01). Moreover, treatment with TMZ also resulted in significant decrease in left ventricular end-systolic volume (WMD: −17.09 ml, 95% CI: −20.15 to −14.04, p<0.01), left ventricular end-diastolic volume (WMD: −11.24 ml, 95% CI: −14.06 to −8.42, p<0.01), hospitalization for cardiac causes (RR: 0.43, 95% CI: 0.21 to 0.91, p = 0.03), B-type natriuretic peptide (BNP; WMD: −157.08 pg/ml, 95% CI: −176.55 to −137.62, p<0.01) and C-reactive protein (CRP; WMD: −1.86 mg/l, 95% CI: −2.81 to −0.90, p<0.01). However, there were no significant differences in exercise duration and all-cause mortality between patients treated with TMZ and placebo.ConclusionsTMZ treatment in CHF patients may improve clinical symptoms and cardiac function, reduce hospitalization for cardiac causes, and decrease serum levels of BNP and CRP.

Highlights

Chronic heart failure (CHF) is a complex clinical syndrome characterized by decreased myocardial contractility, hemodynamic abnormality and neuroendocrine activation
Left ventricular function Our results indicated that additional TMZ therapy was superior to conventional treatment in terms of LVEF improvement (WMD: 7.29%, 95% CI: 6.49 to 8.09, p,0.01) (Figure 2A)
LVESV and LVEDV were significantly lower in patients who received TMZ therapy than placebo treatment (WMD: 217.09 ml, 95% CI: 220.15 to 214.04, p,0.01; weighted mean differences (WMD): 211.24 ml, 95% CI: 214.06 to 28.42, p,0.01, respectively) (Figures 2B and 2C)

Summary

Methods

Search strategy and selection criteria We performed an electronic literature search of PubMed, EMBASE, and Cochrane databases through October 2013, using the terms ‘‘Trimetazidine’’, ‘‘Vastarel’’, ‘‘Idaptan’’, ‘‘heart failure’’, ‘‘cardiac failure’’, ‘‘cardiac dysfunction’’, ‘‘cardiac insuffi-. RCTs reporting at least one of the outcomes were considered eligible. These outcomes included cardiac function parameters (ie, left ventricular ejection fraction (LVEF), left ventricular endsystolic volume (LVESV), left ventricular end-diastolic volume (LVEDV)), New York Heart Association (NYHA) classification, exercise tolerance (ie, exercise duration), all-cause mortality, hospitalization, cardiovascular events, B-type natriuretic peptide (BNP), and C-reactive protein (CRP). Data extraction and quality assessment Two investigators independently reviewed all potentially eligible studies using predefined eligibility criteria and collected data from the included trials. We extracted details on study characteristics, patient characteristics, inclusion criteria, ischemic etiology, intervention strategies, duration of follow-up, and clinical outcomes including LVEF, LVESV, LVEDV, NYHA classification, exercise duration, all-cause mortality, hospitalization, BNP and CRP.

Results

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