抗狹心症藥物 Trimetazidine 不僅有效增加左心室射血體積,還會提升HRV

The effects of trimetazidine on heart rate variability in patients with heart failure.

Arq Bras Cardiol.  2009; 93(2):154-8 (ISSN: 1678-4170)

Gunes Y; Guntekin U; Tuncer M; Sahin M
Yuzuncu Yil University, Faculty of Medicine, Cardiology Department, Van, Turkey. yilmazleman@yahoo.com

BACKGROUND: Reduced measures of heart rate variability (HRV) have been shown to be related with prognosis in heart failure. Chronic administration of trimetazidine in addition to the conventional therapy has been shown to improve functional class and left ventricular functions of heart failure patients.

OBJECTIVE: To assess the effects of trimetazidine on HRV in optimally treated patients with heart failure of ischemic origin.

METHODS: Trimetazidine 20 mg three times/day was added to therapy of 30 patients with heart failure being treated with angiotensinogen converting enzyme inhibitors or angiotensin receptor blockers, carvedilol, spironolactone, digitalis and furosemide. The etiology of heart failure was coronary artery disease in all patients. Patients were evaluated with echocardiography and 24-hour heart rate variability analysis before and 3 months after addition of trimetazidine.

RESULTS: Mean left ventricular ejection fraction (LVEF) significantly increased after the addition of trimetazidine (33.5+/-5.1% to 42.5+/-5.8%, p<0.001). Of the HRV parameters, SDNN (97.3+/-40,1 to 110.5+/-29,2 msecs, p=0.049) and SDANN (80.5+/-29,0 to 98.3+/-30,5 msecs) were significantly increased after trimetazidine treatment. Baseline SDNN was significantly correlated with baseline LVEF (r=0.445, p=0.023, p=0.008) and the increment in SDNN was correlated with increase in LVEF (r=0.518, p=0.007).

CONCLUSIONS: Adding trimetazidine to optimal medical therapy in patients with heart failure of ischemic origin may improve heart rate variability in association with improved left ventricular ejection fraction.