[SD-FORUM-LAT] 40E RE: Trimetazidina. Dr. Perez Riera
SCD Symposium
info en scd-symposium.org
Lun Oct 16 23:47:48 ART 2006
Español - Portugués
Español
Estimado Dr. Salim Ben Khedda, de la División de Cardiología del
Hospital Mustapha, Centro Médico de Algeria:
Soy Andrés Ricardo Pérez Riera de San Pablo, Brasil.
Hay varios trabajos randomizados, principalmente de Italia (Clinical
Cardiology-Heart Failure Unit, Istituto Scientifico-Universita Vita/
Salute San Raffaele, Milan) pero no directamente relacionados con la
mortalidad.
Por favor, vean más adelante:
Principales referencias indexadas sobre Trimetazidina con metodología
de doble ciego y randomización.
Cordialmente,
Andrés Ricardo Pérez Riera
Chief of Electro-Vectocardiology Sector of the Discipline of
Cardiology,ABC Faculty of Medicine (FMABC), Foundation of ABC
(FUABC)- Santo André -São Paulo - Brazil. Rua Sebastião Afonso 885 -
Zip Code: 044417-100- Jardim Miriam S.P.- Brazil
--------
Portugués
Caro Dr Salim Ben Khedda da Divisão de Cardiologia do Mustapha
Hospital Centro médico Algeirs Algeria: aqui é Andrés Ricardo Pérez
Riera de Sao Paulo Brasil.
Eles são vários artigos andomizados, principalmente da Itália
(Clinical Cardiology-Heart Failure Unit, Istituto Scientifico-
Universita Vita/Salute San Raffaele,Milan ) mas não relacionados
diretamente a mortalidade.
Por favor veja abaixo.
Principais referências indexadas com metodologia duplo-cego randomizada.
Tudo de Bom
Andrés Ricardo Pérez Riera
Chefe do Setor de Eletrovetocardiografia da Disciplina de
Cardiologia, Faculdade de Medicna do ABC (FMABC), Fundação do ABC
(FUABC)- Santo André -São Paulo - Brasil. Rua Sebastião Afonso 885 -
CEP: 044417-100- Jardim Miriam S.P.- Brasil
Referencias - Referências
Fragasso G, Palloshi A, Puccetti P, et al. A randomized clinical
trial of trimetazidine, a partial free fatty acid oxidation
inhibitor, in patients with heart failure. J Am Coll Cardiol. 2006;48
(5):992-8.
Clinical Cardiology-Heart Failure Unit, Istituto Scientifico-
Universita Vita/Salute San Raffaele, Milan, Italy.
gabriele.fragasso en hsr.it
OBJECTIVES: This study sought to assess whether the long-term
addition of trimetazidine to conventional treatment could improve
functional class, exercise tolerance, and left ventricular function
in patients with heart failure (HF). BACKGROUND: Previous small
studies have shown that trimetazidine may be beneficial in terms of
left ventricular function preservation and control of symptoms in
patients with post-ischemic HF. METHODS: Fifty-five patients with HF
were randomly allocated in an open-label fashion to either
conventional therapy plus trimetazidine (20 mg three times daily) (28
patients) or conventional therapy alone (27 patients). Mean follow-up
was 13 +/- 3 months. At study entry and at follow-up, all patients
underwent exercise testing and two-dimensional echocardiography.
Among the others, New York Heart Association (NYHA) functional class
and ejection fraction (EF) were evaluated. RESULTS: In the
trimetazidine group, NYHA functional class significantly improved
compared with the conventional therapy group (p < 0.0001). Treatment
with trimetazidine significantly decreased left ventricular end-
systolic volume (from 98 +/- 36 ml to 81 +/- 27 ml, p = 0.04) and
increased EF from 36 +/- 7% to 43 +/- 10% (p = 0.002). On the
contrary, in the conventional therapy group, both left ventricular
end-diastolic and -systolic volumes increased from 142 +/- 43 ml to
156 +/- 63 ml, p = 0.2, and from 86 +/- 34 ml to 104 +/- 52 ml, p =
0.1, respectively; accordingly, EF significantly decreased from 38
+/- 7% to 34 +/- 7% (p = 0.02). CONCLUSIONS: In conclusion, long-term
trimetazidine improves functional class and left ventricular function
in patients with HF. This benefit contrasts with the natural history
of the disease, as shown by the decrease of EF in patients on
standard HF therapy alone.
PMID: 16949492 [PubMed - indexed for MEDLINE]
Fragasso G, Montano C, Perseghin G, Palloshi A, et al. The anti-
ischemic effect of trimetazidine in patients with postprandial
myocardial ischemia is unrelated to meal composition. Am Heart J.
2006;151:1238.e1-8.
Heart Failure Unit, Clinical Cardiology, Istituto Scientifico/
Universita' San Raffaele, Milan, Italy. gabriele.fragasso en hsr.it
BACKGROUND: Previous studies provide evidence for a significant
reduction of coronary flow reserve after ingestion of meals of
different compositions. A possible role of hyperinsulinemia and
increased free fatty acid levels, which are deleterious during acute
myocardial ischemia and reperfusion, has been hypothesized. We
assessed in patients with stable coronary disease the effects of high-
fat meals (HFMs) and high-carbohydrate meals (HCMs) on ischemic
threshold and stress left ventricular function on placebo and after
partial fatty acid inhibition by trimetazidine (TMZ). METHODS: Ten
patients (9 men, age 68 +/- 7 years) were allocated to placebo and
TMZ (40 mg TID), both administered in the 24 hours preceding testing,
according to a randomized double-blind study design. All patients
underwent stress (treadmill exercise testing according to the Bruce
protocol) echocardiography after fasting (8 hours) and after an HFM
and HCM (2 hours) either on placebo or on TMZ. Time to 1-mm ST-
segment depression (time to 1 mm) and stress wall motion score index
(WMSI) were evaluated. RESULTS: An HFM did not affect exercise
variables compared with fasting, whereas an HCM resulted in a
reduction of the ischemic threshold (time to 1 mm from 402 +/- 141 to
292 +/- 123 seconds, P = .025). Compared with placebo, TMZ improved
time to 1 mm after fasting, HFM, and HCM (432 +/- 153 vs 402 +/- 141,
439 +/- 118 vs 380 +/- 107, 377 +/- 123 vs 292 +/- 123, F(1,9) =
26.91, P = .0006). Compared with placebo, on TMZ, stress WMSI
decreased from 1.55 +/- 0.25 to 1.29 +/- 0.14 after fasting, from
1.57 +/- 0.10 to 1.39 +/- 0.28 after HFM, and from 1.64 +/- 0.21 to
1.39 +/- 0.21 after HCM (F(1,9) = 37.04, P = .0002). Interestingly,
stress WMSI on TMZ was never different from rest WMSI on placebo.
CONCLUSIONS: In patients with coronary disease, exercise testing
after an HCM results in more severe myocardial ischemia compared with
that after an HFM. The observed beneficial effects of the partial
fatty acid inhibitor TMZ seem to be unrelated to meal composition and
are possibly caused by the better glucose use induced by the drug.
PMID: 16781225 [PubMed - indexed for MEDLINE]
Fragasso G, Perseghin G, De Cobelli F, et al.Effects of metabolic
modulation by trimetazidine on left ventricular function and
phosphocreatine/adenosine triphosphate ratio in patients with heart
failure. Eur Heart J. 2006;27:942-948.
Department of Clinical Cardiology, Heart Failure Clinic, Istituto
Scientifico/Universita' San Raffaele, Via Olgettina 60, 20132 Milano,
Italy. gabriele.fragasso en hsr.it
AIMS: The addition of trimetazidine to standard treatment has been
shown to improve left ventricular (LV) function in patients with
heart failure. The aim of this study is to non-invasively assess, by
means of in vivo 31P-magnetic resonance spectroscopy (31P-MRS), the
effects of trimetazidine on LV cardiac phosphocreatine and adenosine
triphosphate (PCr/ATP) ratio in patients with heart failure. METHODS
AND RESULTS: Twelve heart failure patients were randomized in a
double-blind, cross-over study to placebo or trimetazidine (20 mg
t.i.d.) for two periods of 90 days. At the end of each period, all
patients underwent exercise testing, 2D echocardiography, and MRS.
New York Heart Association (NYHA) class, ejection fraction (EF),
maximal rate-pressure product, and metabolic equivalent system (METS)
were evaluated. Relative concentrations of PCr and ATP were
determined by cardiac 31P-MRS. On trimetazidine, NYHA class decreased
from 3.04+/-0.26 to 2.45+/-0.52 (P = 0.005), whereas EF (34+/-10 vs.
39+/-10%, P = 0.03) and METS (from 7.44+/-1.84 to 8.78+/-2.72, P =
0.03) increased. The mean cardiac PCr/ATP ratio was 1.35+/-0.33 with
placebo, but was increased by 33% to 1.80+/-0.50 (P = 0.03) with
trimetazidine. CONCLUSION: Trimetazidine improves functional class
and LV function in patients with heart failure. These effects are
associated to the observed trimetazidine-induced increase in the PCr/
ATP ratio, indicating preservation of the myocardial high-energy
phosphate levels.
PMID: 16510466 [PubMed - indexed for MEDLINE
Iskesen I, Saribulbul O, Cerrahoglu M,et al. Trimetazidine reduces
oxidative stress in cardiac surgery. Circ J. 2006 Sep;70(9):1169-73.
Department of Cardiovascular Surgery, Celal Bayar University School
of Medicine, Turkey. iskesen en yahoo.com
BACKGROUND: Trimetazidine is an anti-ischemic agent that is used to
treat angina and it has cardioprotective effects without inducing any
significant hemodynamic changes. It inhibits the long-chain
mitochondrial 3-ketoacyl coenzyme A thiolase enzyme in the myocyte
and can improve cardiac mitochondrial metabolism, as well as scavenge
free radicals. The aim of this double-blind prospective randomized
study was to investigate the effect of preoperative use of
trimetazidine on the reduction of oxidative stress during coronary
artery bypass grafting (CABG) under cardiopulmonary bypass (CPB).
METHODS AND RESULTS: The study group (group T) and the control group
(group C) each comprised 12 patients. Pretreatment began 2 weeks
before CABG with trimetazidine (60 mg/day po); the control group did
not receive any medication. Serial blood samples were collected
before and after CPB for measurement of the serum concentrations of
these major endogenous antioxidant enzyme systems, which are markers
for oxidative degradation of the cellular membranes; postoperative
levels were significantly different between the groups (p<0.05).
There were no significant difference in hemodynamic values.
CONCLUSION: The findings suggest that pretreatment with trimetazidine
alleviates malondialdehyde production and preserves endogenous
antioxidant capacity during CABG with CPB and cardioplegic arrest.
PMID: 16936431 [PubMed - indexed for MEDLINE]
Chaloupka V. Trimetazidine in the treatment of stable angina pectoris
TRIADA-(trimetazidine in stable angina twice daily) Vnitr Lek. 2006
Jun;52(6):609-14. [Article in Czech]
Interni kardiologicka klinika Lekarske fakulty MU a FN Brno.
vchaloup en fnbrno.cz
Links
Comment in:
Vnitr Lek. 2006 Jun;52(6):556-7.
Vnitr Lek. 2006 Jun;52(6):558-9.
The primary objective of the national study TRIADA was to evaluate
the efficacy and tolerability of Preductal MR (trimetazidine) at a
dose of 35 mg twice daily which was added to current therapy
involving the maximum of two antianginal drugs. The outcome was
evaluated after 12 weeks of therapy and compared with baseline data.
The study included 74 patients with stable exertional angina pectoris
(AP) and positive exercise testing results. Trimetazidine (Preductal
MR) at a dose of 35 mg twice daily was added to their current therapy
involving two drugs at most. TRIADA confirmed that the use of
trimetazidine in a new pharmacological form is effective and well
tolerated in the treatment of angina pectoris. The study also
confirmed a beneficial effect of trimetazidine on the incidence of
angina pectoris paroxysms and objective manifestations of ischaemia
during exercise testing. Holter monitoring clearly showed that
metabolic therapy added to standard antianginal therapy would reduce
the incidence of symptomatic and asymptomatic ischaemia. In addition,
12-week therapy with trimetazidine helped improve all end points of
quality of life of AP patients evaluated using a questionnaire for AP
patients (The Seattle Angina Questionnaire).
PMID: 16871765 [PubMed - indexed for MEDLINE]
Topal E, Ozdemir R, Barutcu I, et al. The effects of trimetazidine on
heart rate variability in patients with slow coronary artery flow. J
Electrocardiol. 2006 Apr;39(2):211-8.
Cardiology Department, Faculty of Medicine, Inonu University, Malatya
34300, Turkey.
OBJECTIVE: We sought to examine the effect of trimetazidine (TMZ) on
heart rate variability (HRV), endothelin-1 (ET-1), NO, and anginal
symptoms in patients with slow coronary artery flow (SCAF). METHODS:
The 48 patients with SCAF (29 women and 19 men; mean age, 52 +/- 9
years) were included in the study. Twenty milligrams TMZ 3 times a
day or matched placebo were given randomly in a double-blinded
fashion for 4 weeks. Patients were divided into 4 groups as follows:
exercise-positive, TMZ-given group (group A, n = 12); exercise-
positive, placebo-given group (group B, n = 12); exercise-negative,
TMZ-given group (group C, n = 12); and exercise-negative, placebo-
given group (group D, n = 12). RESULTS: After TMZ treatment, HRV
parameters, including SD of the all R-R intervals, SD of the averages
of R-R intervals in all 5-minute segments of the entire recording,
percentage of R-R intervals with more than 50-millisecond variation,
and the square root of the mean of the sum of the squares of
differences between adjacent R-R intervals, significantly improved
both in exercise-positive and exercise-negative groups when compared
with baseline. After TMZ treatment, ET-1 and NO levels significantly
altered both in exercise-positive and exercise-negative groups when
compared with baseline (17.7 +/- 2.7 vs 13.9 +/- 2.8 pg/mL [P = .01]
and 18.1 +/- 3.8 vs 14.2 +/- 2.6 pg/mL [P = .01], respectively).
After TMZ treatment, NO levels significantly increased in both
exercise-positive and exercise-negative groups when compared with
baseline (36.4 +/- 5.4 vs 43.3 +/- 6.8 micromol/L [P = .01] and 36.8
+/- 7.8vs 43.3 +/- 4.8 micromol/L [P = .01], respectively). However,
in placebo group, neither HRV parameters nor ET-1 and NO levels
altered when compared with baseline. Also, after treatment, a
significant correlation was detected between HRV parameters,
including SD of the averages of R-R intervals in all 5-minute
segments of the entire recording, SD of the all R-R intervals,
percentage of R-R intervals with more than 50-millisecond variation,
and the square root of the mean of the sum of the squares of
differences between adjacent R-R intervals, and NO and ET-1 levels in
TMZ group but not placebo. CONCLUSION: Short-term TMZ therapy
improved HRV parameters and endothelial products such as ET-1 and NO
as well as anginal symptom in patients with SCAF. Improvement in HRV
parameters was correlated with ET-1 and NO levels.
PMID: 16580422 [PubMed - indexed for MEDLINE]
--
Dr. Sergio Dubner
President of Scientific Committee
Dr. Edgardo Schapachnik
President of Steering Committee
> Español - Portugués
>
> Español
>
> Estimados colegas:
> Felicitaciones por este excelente evento.
> Quisiera preguntarle al Dr. Andrés Ricardo Pérez Riera, en términos
> de medicina basada en evidencias, ¿hay algún ensayo que muestre una
> mejora de la morbi-mortalidad al usar trimetazidina (TMZ) vartel?
> Muchas gracias por su consideración a este mensaje.
> salim BEN KHEDDA
> cardiology division
> Mustapha Hospital medical Center
> Algeirs Algeria
>
> ---------
>
> Portugués
>
> Caros colegas,
> Congratulações por este excelente encontro:
> Eu gostaria de pergunatr ao Dr Andrés Ricardo Pérez Riera. em
> termos de ^medicina baseada em evidência existe algum estudo
> demonstrando a morbi-mortalidade com o uso da Trimetazidina (TMZ)
> Vastarel
> Muito obrigado por sua consideração com esta menssagem.
> salim BEN KHEDDA
> Disisão de Cardiologia
> Mustapha Hospital medical Center
> Algeirs Algeria
>
>
> --
> Dr. Sergio Dubner
> President of Scientific Committee
>
> Dr. Edgardo Schapachnik
> President of Steering Committee
>
>
>
>
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