Effect of partial inhibition of fatty acid oxidation by trimetazidine on whole body energy metabolism in patients with chronic heart failure

Objective Trimetazidine may have beneficial effects on left ventricular (LV) function in patients with systolic heart failure. The authors assessed whether long-term addition of trimetazidine to conventional treatment could improve, along with LV function, resting whole body energy metabolism in patients with chronic systolic heart failure. Design Single blind randomised study. Setting University Hospital. Patients 44 patients with systolic heart failure receiving full medical treatment. Interventions Indirect calorimetry and two-dimensional echocardiography at baseline and after 3 months. Main outcome measures Whole body resting energy expenditure (REE), percentage of predicted REE, LV ejection fraction (EF), NYHA class, quality of life. Results Trimetazidine increased EF compared with conventional therapy alone (from 35 +/- 8% to 42 +/- 11% vs from 35 +/- 7% to 36 +/- 6%; p=0.02, analysis of variance for repeated measures). NYHA class and quality of life also improved compared with conventional therapy (p<0.0001). REE (from 1677 +/- 264 to 1580 +/- 263 kcal/day) and percentage of predicted REE (based on the Harris-Benedict equation: from 114 +/- 10% to 108 +/- 9%) decreased in the trimetazidine group, but not in the control group (REE from 1679 +/- 304 to 1690 +/- 337 kcal/day and percentage of predicted REE from 113 +/- 12% to 115 +/- 14%). The variation was different between groups (p=0.03 and 0.023, respectively). Conclusions In patients with systolic heart failure, improvement in functional class and LV function induced by middle-term trimetazidine therapy is paralleled by a reduction in whole body REE. The beneficial cardiac effects of trimetazidine may be also mediated by a peripheral metabolic effect.