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Trimetazidine is a metabolic modulator that may optimize myocardial energy metabolism and allow more efficient production of energy from glucose than from free fatty acids. Trimetazidine has been studied extensively in heart failure predominantly of ischemic origin. Tuunanen et al (1) have now used PET and echocardiographic imaging in a small group of patients with heart failure caused by nonischemic dilated cardiomyopathy. They showed that trimetazidine 1) improves LV function in these patients, 2) reduced myocardial free fatty acid oxidation by only 10% in the failing human heart, raising the possibility of additional mechanisms of action, 3) has whole-body metabolic effects with increased sensitivity potentially linked to decreased whole-body free fatty acid oxidation and 4) increases HDL levels by 11%. Furthermore, the trimetazidine induced improvement in left ventricular function was linked to the degree of beta-blockade, suggesting an additive effect of these 2 therapies. Further studies are of course warranted, but the authors have shown nicely how integrated imaging (in this case PET and echocardiography) may help to study the effects of metabolic modulators in patients with chronic heart failure.
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