In patients with ischemic cardiomyopathy, mortality rate and quality of life are unsatisfactory. We investigated the effects of the metabolic agent trimetazidine (TMZ) on exercise tolerance and prognostic markers B-type natriuretic peptide (BNP) and cardiac troponin T (cTnT) plasma levels.

Fifty patients with ischemic cardiomyopathy were randomized either to receive TMZ (20 mg, TID) in addition to their conventional treatment (TMZ group, n = 25) or to continue their usual drug therapy (control group, n = 25) for 6 months. Patients were evaluated at baseline, at 1 month, and at 6 months (echocardiography and 6-minute walking test). At enrollment and at the end of follow-up, blood testing was performed for determination of BNP and cTnT plasma levels.

After 6 months, no significant New York Heart Association class changes occurred in all patients (P = NS). In the TMZ group, a significant increase of exercise tolerance (P < .01) was detected, whereas left ventricular ejection fraction was unchanged (28% ± 4%, 29% ± 5%, and 32% ± 5% at baseline, at 1 month, and at 6 months, respectively; P = NS). In the TMZ group, BNP was significantly reduced (6 months, 135 ± 22 vs 252 ± 44 pg/mL; P < .001), whereas it was significantly increased in controls (6 months, 288 ± 46 vs 239 ± 59 pg/mL; P < .02); cTnT significantly (P < .001) reduced during TMZ treatment, whereas it was unchanged in the control group.

Six-month TMZ treatment improves exercise tolerance and reduces plasma levels of BNP and cTnT in patients with compensated ischemic cardiomyopathy.