Korean Circ J.  2016 May;46(3):343-349. 10.4070/kcj.2016.46.3.343.

Effects of Trimetazidine on T Wave Alternans in Stable Coronary Artery Disease

• Yaman M
• Arslan U
• GümrükçüoÄŸlu HA
• Åžahin M
• ÅžimÅŸek H
• AkdaÄŸ S

• KMID: 2344447
• DOI: http://doi.org/10.4070/kcj.2016.46.3.343

Abstract

BACKGROUND AND OBJECTIVES
Studies reveal that the microvolt T wave alternans (MTWA) test has a high negative predictive value for arrhythmic mortality among patients with ischemic or non-ischemic cardiomyopathy. In this study, we investigate the effects of trimetazidine treatment on MTWA and several echocardiographic parameters in patients with stable coronary artery disease.
SUBJECTS AND METHODS
One hundred patients (23 females, mean age 55.6±9.2 years) with stable ischemic heart disease were included in the study group. Twenty-five age- and sex-matched patients with stable coronary artery disease formed the control group. All patients were stable with medical treatment, and had no active complaints. Trimetazidine, 60 mg/day, was added to their current treatment for a minimum three months in the study group and the control group received no additional treatment. Pre- and post-treatment MTWA values were measured by 24 hour Holter testing. Left ventricular systolic and diastolic functions were assessed by echocardiography.
RESULTS
After trimetazidine treatment, several echocardiographic parameters related with diastolic dysfunction significantly improved. MTWA has been found to be significantly improved after trimethazidine treatment (63±8 µV vs. 53±7 µV, p<0.001). Abnormal MTWA was present in 29 and 11 patients pre- and post-treatment, respectively (p< 0.001).
CONCLUSION
Trimetazidine improves MTWA, a non-invasive determinant of electrical instability. Moreover, several echocardiographic parameters related with left ventricular functions also improved. Thus, we can conclude that trimetazidine may be an effective agent to prevent arrhythmic complications and improve myocardial functions in patients with stable coronary artery disease.

Keyword

Ischemic heart disease; Trimetazidine; Electrocardiography; Echocardiography

MeSH Terms

Cardiomyopathies
Coronary Artery Disease*
Coronary Vessels*
Echocardiography
Electrocardiography
Female
Humans
Mortality
Myocardial Ischemia
Trimetazidine*
Ventricular Function, Left
Trimetazidine

Reference

1. Armoundas AA, Tomaselli GF, Esperer HD. Pathophysiological basis and clinical application of T-wave alternans. J Am Coll Cardiol. 2002; 40:207–217.

2. Verrier RL, Malik M. Clinical applications of T-wave alternans assessed during exercise stress testing and ambulatory ECG monitoring. J Electrocardiol. 2013; 46:585–590.

3. Merchant FM, Sayadi O, Moazzami K, Puppala D, Armoundas AA. T-wave alternans as an arrhythmic risk stratifier: state of the art. Curr Cardiol Rep. 2013; 15:398.

4. Chobanian AV, Bakris GL, Black HR, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, et al. National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure: the JNC 7 Report. JAMA. 2003; 289:2560–2572.

5. American Diabetes Association. Standards of medical care in diabetes--2010. Diabetes Care. 2010; 33:Suppl 1. S11–S61.

6. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002; 106:3143–3421.

7. Nearing BD, Verrier RL. Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol (1985). 2002; 92:541–549.

8. Sakaki K, Ikeda T, Miwa Y, et al. Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: a prospective study. Heart Rhythm. 2009; 6:332–337.

9. Maeda S, Nishizaki M, Yamawake N, et al. Ambulatory ECG-based T-Wave alternans and heart rate turbulence predict high risk of arrhythmic events in patients with old myocardial infarction. Circ J. 2009; 73:2223–2228.

10. Shimada H, Nishizaki M, Fujii H, et al. Ambulatory electrocardiogram-based T-wave alternans in patients with vasospastic angina during asymptomatic periods. Am J Cardiol. 2012; 110:1446–1451.

11. Vitale C, Wajngaten M, Sposato B, et al. Trimetazidine improves left ventricular function and quality of life in elderly patients with coronary artery disease. Eur Heart J. 2004; 25:1814–1821.

12. Fedorova TA, Il’ina IV, Sotnikova TI, Rybakova MK. Potentialities of cytoprotection in the treatment of chronic heart failure in patients with coronary heart disease. Klin Med (Mosk). 2004; 82:15–20.

13. Belardinelli R, Cianci G, Gigli M, Mazzanti M, Lacalaprice F. Effects of trimetazidine on myocardial perfusion and left ventricular systolic function in type 2 diabetic patients with ischemic cardiomyopathy. J Cardiovasc Pharmacol. 2008; 51:611–615.

14. Multicentral Collaborative Group on Trimetazidine (Phase IV). Therapeutic value of trimetazidine in patients with coronary heart disease and left ventricular dysfunction. Zhonghua Xin Xue Guan Bing Za Zhi. 2005; 33:793–795.

15. Spector KS. Diabetic cardiomyopathy. Clin Cardiol. 1998; 21:885–887.

16. Soliman OI, van Dalen BM, Theuns DA, et al. The ischemic etiology of heart failure in diabetics limits reverse left ventricular remodeling after cardiac resynchronization therapy. J Diabetes Complications. 2009; 23:365–370.

17. Di Napoli P, Di Giovanni P, Gaeta MA, D’Apolito G, Barsotti A. Beneficial effects of trimetazidine treatment on exercise tolerance and B-type natriuretic peptide and troponin T plasma levels in patients with stable ischemic cardiomyopathy. Am Heart J. 2007; 154:602.e1–602.e5.

18. Baykan M, Yilmaz R, Celik S, Orem C, Kaplan S, Erdol C. Assessment of left ventricular systolic and diastolic function by Doppler tissue imaging in patients with preinfarction angina. J Am Soc Echocardiogr. 2003; 16:1024–1030.

19. Cosson S, Kevorkian JP, Virally ML, et al. No evidence for left ventricular diastolic dysfunction in asymptomatic normotensive type 2 diabetic patients: a casecontrol study with new echocardiographic techniques. Diabetes Metab. 2007; 33:61–67.

20. Düzenli MA, Özdemir K, Aygül N, Zengin K, Gök H. The role of tissue Doppler echocardiography in the evaluation of functional capacity of patients with heart failure. Turk Kardiyol Dern Ars. 2008; 36:143–149.

21. Mornos C, Cozma D, Rusinaru D, et al. A novel index combining diastolic and systolic Tissue Doppler parameters for the non-invasive assessment of left ventricular end-diastolic pressure. Int J Cardiol. 2009; 136:120–129.