Effects of metabolic modulation by trimetazidine on left ventricular function and phosphocreatine/adenosine triphosphate ratio in patients with heart failure
Effects of metabolic modulation by trimetazidine on left ventricular function and phosphocreatine/adenosine triphosphate ratio in patients with heart failure
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DOI：
10.1093/eurheartj/ehi816
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发表时间：
2006-04-01
影响因子：
39.3
通讯作者：
Margonato, A
中科院分区：
文献类型：
--
作者：
Fragasso, G;Perseghin, G;Margonato, A
目的 在标准治疗中添加曲美他嗪已被证明可以改善心力衰竭患者的左心室 (LV) 功能。本研究的目的是通过体内 P-31 磁共振波谱 (P-31-MRS) 无创评估曲美他嗪对心力衰竭患者左心室心脏磷酸肌酸和三磷酸腺苷 (PCr/ATP) 比率的影响。 方法和结果 在一项双盲、交叉研究中，12 名心力衰竭患者被随机分配至安慰剂或曲美他嗪（20 mg tid），每组两次期限为 90 天。在每个周期结束时，所有患者均接受运动测试、二维超声心动图和MRS。评估了纽约心脏协会 (NYHA) 等级、射血分数 (EF)、最大心率-压力乘积和代谢当量系统 (METS)。 PCr 和 ATP 的相对浓度通过心脏 P-31-MRS 测定。服用曲美他嗪后，NYHA 分级从 3.04 +/- 0.26 下降至 2.45 +/- 0.52 (P=0.005)，而 EF（34 +/- 10 与 39 +/- 10%，P=0.03）和 METS（从 7.44 +/- 1.84 至 8.78 +/- 2.72，P=0.03）增加。安慰剂组的平均心脏 PCr/ATP 比率为 1.35 +/- 0.33，但曲美他嗪组增加了 33%，达到 1.80 +/- 0.50 (P=0.03)。结论 曲美他嗪改善心力衰竭患者的功能等级和左心室功能。这些作用与观察到的曲美他嗪诱导的 PCr/ATP 比率增加有关，表明心肌高能磷酸盐水平得到保留。
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 P-31-magnetic resonance spectroscopy (P-31-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 P-31-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.