Belardinelli Romualdo, Lacalaprice Francesca, Faccenda Ernesto, Volpe Loretta
Cardiac Rehabilitation and Prevention, Lancisi Heart Institute, Ancona, Italy.
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):533-40. doi: 10.1097/HJR.0b013e328304feec.
Patients referred for cardiac rehabilitation may take advantage from combining trimetazidine (TMZ) with exercise training (ET), as both treatments produce similar effects in the cardiovascular system. It is, however, unknown whether the combination of TMZ with ET may determine greater improvements in functional capacity and endothelial function than ET alone.
A randomized longitudinal controlled study.
We studied 116 patients (97 men and 19 women, mean age 58+/-9 years) with ischemic heart disease and left ventricular dysfunction who were referred for cardiac rehabilitation. Coronary risk factors were present in 82 patients (diabetes in 28 patients). Patients were randomized into three matched groups. A group (TMZ+training, TT, n=30) received TMZ at doses of 20 mg three times daily orally for 8 weeks in addition to standard medications and underwent a supervised program of ET at 60% of oxygen uptake at peak, three times a week for 8 weeks. A group (exercise, E, n=30) completed the ET program without receiving TMZ. A control group (C, n=26) was neither exercised nor received TMZ. A fourth group (TMZ, n=30) receiving TMZ 20 mg three times daily for 8 weeks was also studied. On study entry and at 8 weeks all patients underwent echocardiography, cardiopulmonary exercise testing, and vasomotor reactivity of the brachial artery.
Oxygen uptake at peak was significantly increased in the TT (25%), TMZ (15.1%), and E group (15.3%) (P<0.001 TT vs. C; P<0.05 vs. TMZ and E). Left ventricular ejection fraction was also improved in TT (18.4%), TMZ (15.7%), and E (12.9%) (P<0.001 TT vs. C; P<0.05 vs. TMZ and E), as a result of reduction in end-systolic volume. The endothelium-dependent dilation was similarly improved (P<0.001 TMZ vs. C; P<0.05 vs. TMZ and E). The most significant improvements were observed in the subgroup TT with multiple risk factors.
The addition of TMZ to ET determined greater improvements in functional capacity, left ventricular ejection fraction, and endothelium-dependent dilation than TMZ or ET given alone. No differences between improvements after TMZ and E as compared with controls were observed.
被转诊接受心脏康复治疗的患者可能会从曲美他嗪（TMZ）与运动训练（ET）相结合的治疗中获益，因为这两种治疗方法在心血管系统中产生的效果相似。然而，TMZ与ET联合使用是否比单独使用ET能在功能能力和内皮功能方面带来更大改善尚不清楚。
一项随机纵向对照研究。
我们研究了116例（97例男性和19例女性，平均年龄58±9岁）患有缺血性心脏病和左心室功能障碍且被转诊接受心脏康复治疗的患者。82例患者存在冠状动脉危险因素（28例患者患有糖尿病）。患者被随机分为三个匹配组。一组（TMZ + 训练组，TT，n = 30）除标准药物治疗外，口服曲美他嗪，剂量为20mg，每日三次，共8周，并接受一项监督下的运动训练计划，运动强度为峰值摄氧量的60%，每周三次，共8周。一组（运动组，E，n = 30）完成运动训练计划但未接受TMZ治疗。对照组（C，n = 26）既不进行运动也不接受TMZ治疗。还研究了第四组（TMZ组，n = 30），该组患者每日三次口服20mg TMZ，共8周。在研究开始时和8周时，所有患者均接受超声心动图检查、心肺运动试验以及肱动脉血管舒缩反应测试。
TT组（25%）、TMZ组（15.1%）和E组（15.3%）的峰值摄氧量均显著增加（TT组与C组相比，P < 0.001；与TMZ组和E组相比，P < 0.05）。由于收缩末期容积减少，TT组（18.4%）、TMZ组（15.7%）和E组（12.9%）的左心室射血分数也有所改善（TT组与C组相比，P < 0.001；与TMZ组和E组相比，P < 0.05）。内皮依赖性舒张功能也有类似改善（TMZ组与C组相比，P < 0.001；与TMZ组和E组相比，P < 0.05）。在具有多种危险因素的TT亚组中观察到最显著的改善。
与单独使用TMZ或ET相比，在ET基础上加用TMZ能在功能能力、左心室射血分数和内皮依赖性舒张功能方面带来更大改善。与对照组相比，TMZ组和E组在改善情况方面未观察到差异。
