Meta-analysis of efficacy of trimetazidine on treatment of ischemic cardiomyopathy

Abstract

Objective To assess the treatment effect of trimetazidine (TMZ) in patients with ischemic cardiomyopathy. Methods An extensively systemic search of three computerized databases (PubMed, EMBASE and Cochrane databases) was performed up to March 2015, and additional appropriate studies were searched in the citations of each included literature and related reviews.Pooled risk ratio (RR) and weighted mean differences (WMD) were calculated using fixed or random effects models. Results Thirteen randomized controlled trials (RCTs) involving 737 ischemic cardiomyopathy patients treated with TMZ or placebo were included.TMZ therapy was significantly associated with improvement of left ventricular ejection fraction (WMD=6.98, 95% CI: 5.52 to 8.45, Z=9.35, P<0.001), 6 minute walk distance (WMD=83.39, 95% CI: 21.36 to 145.43, Z=2.63, P=0.008) and NYHA classification (WMD=4.28, 95% CI: -0.95 to -0.35, Z=4.28, P<0.001). Moreover, TMZ treatment also markedly reduced left ventricular end-systolic diameter (WMD=-6.14, 95% CI: -7.55 to -4.74, Z=8.57, P<0.001), left ventricular end-diastolic diameter (WMD=-5.23, 95% CI: -6.04 to -4.41, Z=12.57, P<0.001), left ventricular end-systolic volume (WMD=-13.22, 95% CI: -21.89 to -4.56, Z=2.99, P=0.003), left ventricular end-diastolic volume (WMD=-11.36, 95% CI: -14.22 to -8.50, Z=7.79, P<0.001), wall motion score index (WMD=-0.22, 95% CI: -0.33 to -0.11, Z=3.99, P<0.001), and cardiovascular events and hospitalization (RR=0.35, 95% CI: 0.22 to 0.56, Z=1.74, P<0.001). However, there was no significant difference in C-reactive protein levels and all-cause mortality between TMZ and control group. Conclusions In patients with ischemic cardiomyopathy, TMZ treatment could effectively improve clinical symptoms and cardiac function, and reduce the risk of hospitalization for cardiac causes. Key words: Trimetazidine; Ischemic cardiomyopathy; Randomized controlled trial; Systematic review; Meta-analysis