Clinical overview of trimetazidine (Vastarel MR) in patients with heart failure

Myocardial energy metabolism may be normal in the early stages of heart failure but, as failure progresses, mitochondrial oxidative metabolism is reduced and glycolysis is increased, with downregulation of glucose oxidation. Reducing free fatty acid oxidation and a concomitant increase in glucose oxidation improve cardiac contraction and slow the progression of left ventricular failure. Trimetazidine (TMZ) acts as a partial inhibitor of fatty acid oxidation and in turn stimulates glucose oxidation. In several studies, treatment with TMZ was found to result in a significant improvement in functional ability, left ventricular function, and the remodeling process in non diabetic, diabetic, ischemic, and non ischemic left ventricular dysfunction. Therefore, there is a compelling argument to advocate the use of TMZ in addition to conventional evidence-based treatments in the management of heart failure. Heart Metab. 2010;47:23‐26.