Cytoprotector Trimetazidine in Complex Therapy of Severe Heart Failure after Myocardial Infarction

Aim. Evaluation of clinical efficacy of trimetazidine in patients with heart failure after myocardial infarction. Material. 130 patients (97 men and 33 women) aged 37-76 years with NYHA class III-IV heart failure after myocardial infarction divided into 2 groups: (1) standard therapy (ACE inhibitor, diuretic and glycoside), (2) standard therapy + trimetazidine. Duration of treatment - 12 months. Methods. Left ventricular function was assessed by echocardiography before and after 6 and 12 months of therapy. Results. 27 patients dropped out from the study due to different reasons. There were 10 deaths (13%) in group 1 and 6 deaths (11,3%) in group 2. Significant lowering of NYHA class was observed in both groups: from 3,31±0,05 to 2,38±0,10 (p<0,001) in group 1 and from 3,32±0,07 to 2,15±0,09 (p<0,001) in group 2. This was associated with improvement of left ventricular systolic function evidenced by significantly decreased end-systolic and end-diastolic volumes, increased cardiac output, ejection fraction, and percentage of fractional shortening. By the end of therapy ejection fraction and percentage of fractional shortening were higher in trimetazidine treated patients. Positive changes of left ventricular diastolic function (reduction of Ve/Va ratio at the account of both decreased early and increased atrial velocities) also occurred.