Assessing the effect of trimetazidine on NYHA functional class in patients with LV systolic dysfunction in a tertiary care centre

 

 

Abstract              Background: Left ventricular systolic dysfunction (LVSD) is one of the most common causes of heart failure and is an increasingly common disorder. Studies have shown that addition of Trimetazidine(TMZ) to standard treatment improve LV function and NYHA functional class thus symptomatic improvement in patients. Shift of metabolism away from a preference for fatty acid towards more carbohydrate oxidation can improve contractile function, thus slowing progression and improving prognosis. Trimetazidine(TMZ) by altering the substrate preference is a promising agent in this new group of modulator drugs. Objectives: To find the effect of addition of Trimetazidine on New York Heart Association (NYHA) functional class, in patients with LV systolic dysfunction receiving optimal medical therapy in comparison with patients receiving only optimal medical therapy. Materials and Methods: Study was conducted in Department of Cardiology, Kannur Medical College, Anjarakandy after approval from Institutional Human Ethical Committee and Research Committee. This is a comparative study in patients with LV systolic dysfunction receiving Trimetazidine along with optimal medical therapy and patients receiving only optimal medical therapy. Study period was from November 2014 to August 2015. Results: The change in NYHA functional class from 3 months period to 6 months follow up period (p value < 0.001) and from baseline to 6 months follow up period (p value<0.001) were found to be significant. This indicates there is a significant improvement in NYHA functional class in TMZ group. Conclusion: The present study showed that shifting the energy substrate preference away from fatty acid metabolism and towards glucose metabolism by TMZ, a specific partial inhibitor of FFA oxidation, added to optimal medical therapy improved NYHA functional class in patient with left ventricular systolic dysfunction. The improvement in left ventricular function is likely the main factor determining the decreased NYHA functional class. However, further investigation through large scale trials is recommended.

Key Word: trimetazidine.