Abstract
To explore the effect of trimetazidine (TMZ) in cardiomyopathy treatment. Literatures, related with TMZ treatment for cardiomyopathy, were retrieved between 1990 and February 2018 in the Pubmed, Embase, and Cochrane Library systems. Cardiopulmonary exercise testing [resting heart rate (RHR), peak heart rate (PHR), peak systolic blood pressure (PSBP), and resting systolic blood pressure (RSBP)] and echocardiographic results [left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), systolic wall thickening score index (SWTSI), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD)] were merged to detect the publication bias. Total 898 patients with cardiomyopathy were divided into two groups: TMZ-treated group (n=456) and control group (n=442). There was no difference in the improvement of cardiomyopathy between the TMZ and control group. No publication bias was shown for PHR (t= 0.9791, P=0.5067). There were significant differences in LVEF, LVESV, SWTSI, LVESD, and LVEDD between the TMZ group and the control group. TMZ-treatment significantly increased the level of LVEF (95% confidence interval (CI): 5.46–7.84, P<0.001), and reduced the level of LVESV (95% CI: −18.73 to −7.77, P<0.001), SWTSI (95% CI: −0.47 to −0.15, Z = −3.85, P=0.001), LVESD (95% CI: −1.09 to −0.08, P<0.001), and LVEDD (95% CI: −0.55 to −0.26, P=0.023). There was no publication bias except for LVEDV (t = 2.5456, P=0.0438). TMZ is effective for cardiomyopathy treatment and worth to popularize in clinic.
Highlights
Cardiomyopathy, defined as myocardial disease associated with cardiac functional insufficiency, is divided into primary and secondary cardiomyopathies [1]
The results showed that peak heart rate (PHR) (TMZ group 49, control group 45, mean difference (MD) = −0.98, 95% confidence interval (CI): −5.25 to 3.29, Z = 1.45, P= 0.1470), peak systolic blood pressure (PSBP) (TMZ group 49, control group 45, MD = 7.53, 95% CI: 0.45–14.62, Z = −0.45, P=0.6519), resting heart rate (RHR) (TMZ group 61, control group 52, MD = −2.83, 95% CI: −6.66 to 0.99, Z = 0.30, P=0.7628), and resting systolic blood pressure (RSBP) (TMZ group 31, control group 26, MD = 1.25, 95% CI: −6.85 to 9.34, Z = 1.67, P=0.0946)
The results showed that left ventricular ejection fraction (LVEF) (TMZ group 456, control group 442, MD = 6.65, 95% CI: 5.46 – 7.84, Z = 10.94, P
Summary
Cardiomyopathy, defined as myocardial disease associated with cardiac functional insufficiency, is divided into primary and secondary cardiomyopathies [1]. It is generally believed that cardiomyopathy is a clinical syndrome with multiple etiologies, such as viral infection, immune response, genetic theory, myocardial ischemia, metabolism and enzyme changes, catecholamine theory, poisoning theory, and nutritional deficiency [3]. Trimetazidine (TMZ), a piperazine derivative which acts on myocardium metabolism, inhibits mitochondrial long-chain acyl coenzyme 3-ketone A thiolase, transfers the energy from metabolism of fatty acid oxidation to glucose oxidation, uses limited oxygen to produce more ATP, and increases the synthesis of phospholipids, so it makes the myocardial cell energy production optimization. TMZ could stimulate glucose metabolism to increase the myocardial tolerance to ischemic injury by inhibiting the β-oxidation pathway of fatty acids [5]. It is necessary to make a c 2018 The Author(s)
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