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Trimetazidine in heart failure with preserved ejection fraction: a randomized controlled cross-over trial
Arno A van de Bovenkamp1,2, Kiki T J Geurkink1, Frank T P Oosterveer3
1Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
ESC Heart Failure
|August 2, 2023
Summary
Trimetazidine failed to improve heart function in patients with heart failure with preserved ejection fraction (HFpEF). The study found no significant benefits in exercise capacity or myocardial energy status with trimetazidine treatment.
Area of Science:
- Cardiology
- Metabolic Medicine
- Exercise Physiology
Background:
- Impaired myocardial energy homeostasis is a key factor in heart failure with preserved ejection fraction (HFpEF) pathophysiology.
- Left ventricular diastolic dysfunction, characterized by high energy demand during relaxation, is linked to compromised energy metabolism.
Purpose of the Study:
- To investigate the efficacy of trimetazidine, a fatty acid oxidation inhibitor, in enhancing myocardial energy homeostasis.
- To determine if trimetazidine improves exercise hemodynamics in patients diagnosed with HFpEF.
Main Methods:
- A phase II, single-center, double-blind, placebo-controlled, randomized crossover trial (DoPING-HFpEF) involving 25 HFpEF patients.
- Patients received trimetazidine or placebo for 3 months, followed by a 2-week washout period.
- Primary endpoint: change in pulmonary capillary wedge pressure during exercise; Secondary endpoint: myocardial phosphocreatine/adenosine triphosphate ratio.
Main Results:
- Trimetazidine did not significantly alter pulmonary capillary wedge pressure during exercise compared to placebo (mean change 0 mmHg, P=0.60).
- Myocardial phosphocreatine/adenosine triphosphate levels were similar between trimetazidine and placebo groups (P=0.08).
- No improvements were observed in exercise capacity (6-min walking distance), quality of life, or diastolic function parameters.
Conclusions:
- Trimetazidine does not improve myocardial energy homeostasis in patients with HFpEF.
- The drug failed to enhance exercise hemodynamics or other clinical parameters in the studied HFpEF population.
Keywords:
Diastolic heart failureExercise toleranceHeart mitochondriaMetabolismPulmonary wedge pressureSwan-Ganz catheterizationMore Related Videos
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