Antianginal effects of trimetazidine and left ventricular function improvement in patients with stable angina pectoris.

OBJECTIVE

To evaluate the effects of add-on treatment with trimetazidine, single dose and long-term, on clinical and objective parameters of ischemia in patients with stable angina pectoris receiving standard antianginal therapy.

DESIGN

One-month single-blind, placebo-controlled study.

PATIENTS

40 patients with stable angina pectoris.

INTERVENTIONS

Patients received 1-month treatment with either trimetazidine 20 mg (n = 20) or placebo (n = 20) 3 times daily in addition to standard antianginal therapy.

MAIN OUTCOME MEASURES

All patients underwent bicycle stress tests at baseline and at 1 month to assess exercise tolerance. Patients receiving trimetazidine also underwent a stress test 2 hours after administration of a 60 mg single dose. Influence of trimetazidine on stress-induced left ventricular function was assessed in 11 patients, with dobutamine stress echocardiography performed at baseline and at 1 month. Clinical efficacy was evaluated in terms of mean weekly number of anginal episodes and weekly nitroglycerin (glyceryl trinitrate) tablet consumption during the study.

RESULTS

Trimetazidine significantly improved most stress test parameters, after a single dose and after 1 month of treatment; the rate-pressure product remained unchanged. Dobutamine tests showed significant (p < 0.05) increases from baseline values in time to onset of anginal pain and threshold dobutamine dose (13.5 +/- 0.7 versus 10.2 +/- 0.8 min, and 43.6 +/- 2.8 versus 35.4 +/- 3.4 microg/kg/min, respectively). The severity of anginal pain and mean weekly number of anginal episodes was reduced significantly (p < 0.05) from baseline values after 1 months' treatment with trimetazidine (1.3 +/- 0.6 versus 2.3 +/- 0.3, and 6.6 +/- 1.4 versus 10.1 +/- 1.3, respectively). After 1 month, weekly consumption of nitroglycerin tablets was decreased by 3.1 from baseline values in the trimetazidine group but increased by 0.3 in the placebo-treated group. No patient withdrew due to treatment-related adverse effects.

CONCLUSION

This study confirms the antianginal and anti-ischemic efficacy of single dose and long-term treatment with trimetazidine. Treatment with trimetazidine was well tolerated.