Bertomeu-Gonzalez Vicente, Bouzas-Mosquera Alberto, Kaski Juan Carlos
Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences, St. George's, University of London, London, United Kingdom.
Am J Cardiol. 2006 Sep 4;98(5A):19J-24J. doi: 10.1016/j.amjcard.2006.07.005. Epub 2006 Jul 24.
Despite treatment with conventional agents, a high proportion of patients with ischemic cardiomyopathy continue to have symptoms. Moreover, a substantial proportion shows progressive contractile dysfunction leading to left ventricular (LV) enlargement and heart failure. Therefore, a need exists for new treatments for ischemic cardiomyopathy that tackle mechanisms other than those already addressed by conventional agents. Emerging evidence suggests that in patients with ischemic cardiomyopathy, LV dysfunction develops as a result of alterations in substrate metabolism, which contribute to contractile dysfunction and the progression of LV remodeling. Trimetazidine, a novel pharmacologic agent that acts on myocardial metabolic pathways, appears to protect the heart from the deleterious effects of ischemia, and it has been shown to enhance LV contractility in patients with stunned or hibernating myocardium. This article reviews recent clinical trials that have assessed the therapeutic role of trimetazidine in patients with ischemic cardiomyopathy. Trimetazidine has been shown to improve symptoms and LV ejection fraction and to have a beneficial effect on the inflammatory profile and endothelial function in these patients. These results suggest that trimetazidine is a useful adjunct to our current armamentarium for the treatment of patients with ischemic cardiomyopathy.
尽管使用了传统药物进行治疗，但仍有很大比例的缺血性心肌病患者持续出现症状。此外，相当一部分患者表现出进行性收缩功能障碍，导致左心室（LV）扩大和心力衰竭。因此，需要针对缺血性心肌病开发新的治疗方法，以解决传统药物尚未涉及的机制问题。新出现的证据表明，在缺血性心肌病患者中，左心室功能障碍是由于底物代谢改变所致，这会导致收缩功能障碍和左心室重构的进展。曲美他嗪是一种作用于心肌代谢途径的新型药物，似乎可以保护心脏免受缺血的有害影响，并且已证明它能增强心肌顿抑或冬眠患者的左心室收缩力。本文综述了近期评估曲美他嗪在缺血性心肌病患者中治疗作用的临床试验。结果表明，曲美他嗪可改善这些患者的症状和左心室射血分数，并对炎症指标和内皮功能产生有益影响。这些结果提示，曲美他嗪是我们目前治疗缺血性心肌病患者药物库中的一种有用辅助药物。
