P1587 Echochardiographic estimation of the impact of long-term treatment with Trimetazidine on myocardial dysfunction in patients with ST elevation myocardial infarction

Abstract

Abstract Outcome of ST elevation acute myocardial infarction (STEMI) is usually complicatedby congestive heart failure (HF) that impacts quality of life and prognosis. Spectrum of myocardial injury depends on intensity of impaired myocardial perfusion and on existing metabolic state. Metabolic changes occurring during early hours of myocardial infarction include increased secretion of catecholamines and production of circulating free fatty acids (FFAs). As myocardium depends on aerobic metabolism increased FFAs exert toxic effect on myocardium resulting in metabolic mismatch, decreased cardiac function and arrhythmias. Our aim was to diminish signs of HF after STEMI especially in patients (P)who could not undergo reperfusion therapy because of different reasons.We used long-term metabolic therapy (MT) with TrimetazidineMR(TMZ)just from the first day of STEMI during 3 months. Evaluation of heart function was based on ECG, Holter monitoring and echocardiographic (Echo) data received before and after treatment. We observed 50 P with STEMI who could not undergo reperfusion therapy. All were treated with standard therapy according to guideline. 35 of them (I group) additionally were treated with TMZ 80 mg p/o once a day for 3 months. The rest15 patients represented II - control group. P including in these groups were comparable according to echocardiographic data. These Patients did not reveal any life-threatening arrhythmias in the acute stage of MI and any prognostically indifferent arrhythmias in the following period. Echoinvestigation in dynamic (before treatment and after 3 months) showed significant improvement of ejection fraction (EF by 14,2%) and stroke volume (SVby14,8%) in patients with STEMI treated with TMZwhile in control group EF (by 4,5%) and SV (by 6,8%) wereincreasedslightly. After 3 months improvement of diastolic function was also prominent in patients treated with TMZ that was revealed by decreased diastolic volume. In patients treated with MT end diastolic diameter (EDD) diminished by 4,8%, end systolic diameter (ESD) - by 5,7%, end diastolic volume (EDV) - by 9,3% and end systolic volume (ESV) - by 14,9% while in control group EDD was decreased by 1,9%, ESD - by 2,8%, EDV - by 4,7% and ESV - by 4,1%. Diastolic dysfunction was also estimatedaccording to left ventricular filling pressure (LVFP) E/ethat was especially interesting in P with HF with mid-range and preserved EF. Before treatment (LVFP) was increased in 17 P from the first group and in 7 P in control group. In the first group increased LVFP significantly decreased in 12 P and moderately in 5, while in control group LVFPwas only decreased moderately in 4and slightly in 3 P. The received data make it relevant to useTMZmetabolic therapy for effective treatment of HF in patients with STEMI. MT not only improves the course of disease, but diminishes rehabilitation period as well.