Trimetazidine On Cardiac Function Of Ischemic Cardiomyopathy Clinical Observation

Ischemic cardiomyopathy (ischemic cardiomyopathy, ICM) is severe myocardialdysfunction due to coronary artery stenosis and occlusion, usually the left ventricular ejectionfraction is lower than40%(LVEF <40%), accompanied by focal or multifocal ventricularwall motion abnormality.Ischemic cardiomyopathy is a special type of coronary heartdisease.The clinical features of ischemic cardiomyopathy are: heart gradually enlarges,cardiac arrhythmia and heart failure occur, which lead to a series of symptoms such aspalpitations, shortness of breath, exercise tolerance reduction and so on..Currently,conventional drug therapy on ischemic cardiomyopathy includes angiotensin-convertingenzyme inhibitors (ACEI), diuretics, beta blockers, nitrates, cardiac glycosides andcombination of antiplatelet drug, yet the outcome is not just as one wishes. Prognosis,exercise tolerance and quality of life of patients with ischemic cardiomyopathy still needfurther improvement.As the first3-keto acyl coenzyme A sulfur lyase inhibitor (3-KAT), trimetazidine(TMZ)is a novel anti-ischemic drug with unique mechanisms. Trimetazidine can maitain cell energymetabolism under ischemic condition, prevent the decline of intracellular ATP levels, thusimprove the myocardial energy metabolism. Trimetazidine can be used for the treatment ofcoronary heart disease, angina pectoris, myocardial infarction, ischemic cardiomyopathy.A large number of animal experiments and clinical trials indicate the protective effect oftrimetazidine on acute myocardial ischemia. As a drug which can regulate myocardial cellmetabolism, trimetazidine can promote myocardial glucose oxidation pathway, inhibite freefatty acid oxidation process, reduce intracellular acidosis and myocardial intracellular sodiumand calcium accumulation, therefore protect myocardial cells in ischemic and hypoxiccondition..Also, many clinical trials showed that trimetazidine can significantly alleviate thesymptoms of angina, improve exercise tolerance, reduce the number of episodes of angina inpatients with coronary heart disease.Trimetazidine plays an active role in myocardial energymetabolism and it does not cause hemodynamic changes.It can improve left ventricular function in patients with left ventricular ejection fraction, and improve the patient’s exercisetolerance.We invesgated trimetazidine’s effect on exercise tolerance in patients with ischemiccardiomyopathy through clinical research.Objective:1.to investigate trimetazidine’effect on cardiac function in patients with ischemiccardiomyopathy;2, to investigate trimetazidine’effect on exercise tolerance in patients with chronic heartfailure;Methods.1.Analyze data of patients with chronic congestive heart failure.caused by ischemiccardiomyopathy who were admitted into PLA252Hospital from Oct,2010to Oct,2011..Thepatients were randomly divided into control and treatment groups.The control group weretreated with angiotensin converting enzyme inhibitors (ACEI), beta blockers, diuretics,digoxin and nitrates and other conventional treatment.. The treatment group was treated withroutine method combined with trimetazidine (TMZ,20mg,3/d).2.6minutes walk test(Using the method proposed by Bittner)3.BNP(measure BNP levels using multifunctional immunoassay4. Left ventricular ejection fraction, left ventricular end-diastolic diameter(using ColorDoppler ultrasound)Result.Compared with control group after the6months’ treatment, cardiac ejection fraction andexercise tolerance of the trimetazidine group improved, while left ventricular end-diastolicdiameter and BNP average level lowered, which were all significant,(P <0.01).Conclusion:Trimetazidine can improve heart function and exercise tolerance in patients withischemic cardiomyopathy;...