The Effect Of Trimetazidine On The Elderly Patients With Chronic Heart Failure And Sarcopenia

Objectives: To assess the impact of sarcopenia on the elderly patients with chronic heart failure(CHF)and study the effect of trimetazidine on the elderly patients with CHF and sarcopenia.Methods: Sixty patients with CHF and sarcopenia were compared with 60 sex and age-matched CHF patients without sarcopenia and randomized to to either trimetazidine group(30 patients)or conventional treatment group(30 patients).Trimetazidine group: conventional therapy plus trimetazidine(20 mg,three times daily);Conventional therapy group:the standardized oral drug therapy alone [diuretic,angiotensin converting enzyme inhibitors(ACEI),angiotensin-II receptor blocker(ARB),beta-receptor blockers(?-RB),aldoste-rone receptor antagonist,digoxin,etc.].At baseline and after the 3 month follow-up,the cardiac function was evaluated by a 6-min walk distance(6-MWD)and left ventricular ejection fraction(LVEF).Skeletal mass was accessed by fat-free mass index(FFMI)and muscle function was accesse d by gait speed(GS),hand strength(HS),the simple physical performanc e battery(SPPB).Moreover,the serum inflammation factors level,such a s IL-6,TNF-?,as well as a novel biomarker of skeletal muscle C1 q,were accessed,respectively.Results:1 Compared to the CHF patients without sarcopenia,the cardiac function decreased significantly in the CHF patients with sarcopenia:6-MWD [(253.76±72.62)vs.(340.91±55.78)m,P=0.000];LVEF[(39.12±7.02)vs.(43.83±5.81)%,P=0.000].And the skeletal muscle mass and muscle function obviously decreased in CHF patients with sarcopenia: FFMI[(17.68±0.74)vs.(18.36±0.54)kg/m2,P=0.000],HS[(17.26±4.20)vs.(28.85±6.43)kg,P=0.000],GS[(0.65±0.11)vs.(0.90±0.10)m/s,P=0.000],SPPB[(6.41±2.08)vs.(7.69±1.75),P=0.000 ].Moreover,the serum inflammation levels were elevated:IL-6[(14.11 ±1.40)vs.(13.46±1.06)ng/l,P=0.006 ],TNF-? [(443.43±28.05)vs.(299.37± 21.53)ng/l,P=0.000],as well as C1 q [(578.92±23.63)vs.(504.1±41.77)ng/l,P=0.000].2 Before and after the treatment,the cardiac function improved in the trimetazidine group: 6-MWD[(251.54±76.60)vs.(311.94±71.03)m,P=0.004 ],LVEF [(38.85±6.63)vs.(44.26±4.85)m,P=0.002].The skeletal function improved significantly:GS[(0.65±0.11)vs.(0.71±0.06)m/s,P=0.049],SPPB[(6.44± 2.08)vs.(7.59±1.80),P=0.035];Conversely,the serum inflammation levels(IL-6/TNF-?)and C1 q were decreased: IL-6[(14.05±1.28)vs.(12.50±0.90)ng/l,P=0.000],TNF-?[(444.76±26.12)vs.(411.11±11.03)ng/l,P=0.000],C1q[(576.70±24.16)vs.(555.49±18.79),P=0.001].In the conventional group,the cardiac function also improved.And the serum inflammation levels were decreased significantly(P<0.05).However,the change of skeletal function and skeletal biomarker C1 q had no statistical difference(P>0.05).3 At follow-up,the patients on trimetazidine therapy showed improved 6-MWD by a mean of(60.40±10.25)m,with the improvement in the conventional group of(39.82±17.86)m(P=0.000).And the LVEF improved by(5.41±1.45)% in trimetazidine group,versus(3.36±2.21)% in the conventional group.And compared with the conventional group,the skeletal function also improved in the trimetazidine group: GS[(0.71±0.06)vs.(0.66±0.10)m,P=0.049],SPPB[(7.59±1.80)vs.(6.57±1.87),P=0.045];On the contrary,serum inflammation levels(IL-6/TNF-?)and C1 q were decreased significantly compared to the conventional group: IL-6[(12.50±0.90)vs.(13.24±1.47)ng/l,P =0.019],TNF-?[(411.11±11.03)vs.(424.91±29.75)ng/l,P=0.006],C1q[(555.49±18.79)vs.(575.54±20.28),P=0.000].Conclusions:1 Compared with the CHF patients without sarcopenia,the patients with CHF and sarcopenia presented lower cardiac function,poorer skeletal muscle mass and skeletal function.2 Trimetazidine could improve cardiac function and skeletal function,which the mechanism may be related to that trimetazidine could improve myocardial metabolism and the function of skeletal muscle directly.