Assessment of antianginal and antiischemic effect of trimetazidine and its effects on myocardial perfusion in patients with ischemic heart disease and stable angina.

AIM: To assess antianginal and antiischemic effects of trimetazidine and its action on myocardial perfusion in patients with ischemic heart disease and stable angina. MATERIAL: Open trimetazidine was given for 3 months to 53 nitroglycerine and beta-blocker treated men aged 47-69 (mean age 60.2+/-0.85) years with ischemic heart disease and stable angina. Stenoses of 1-3 main coronary arteries were found at angiography in 37 of these patients. METHODS: Registration of frequency of anginal attacks and nitroglycerine consumption, treadmill exercise tests and 24-hour ECG monitoring, assessment of severity of myocardial perfusion defects by scintigraphy with (99m)Tc MIBI were used for elucidation of treatment efficacy. RESULTS: After 3 months number of anginal attacks per week decreased from 9.3+/-0.6 to 4.8+/-05% (-48%, p<0.001), weekly nitroglycerine consumption fell from 9.9+/-0.8 to 4.6+/-0.6 pills (-53%, p<0.001), time to ST-segment depression during exercise on treadmill increased from 6.4+/-0.4 to 7.7+/-0.5 min (+16.9%, p<0.001) and total work performed increased from 7.8+/-0.4 to 9.2+/-0.5 METS (+15.2%, p<0.001). According to 24-hour ECG monitoring numbers of episodes of painful and painless ischemia decreased from 4.1+/-0.9 to 1.9+/-0.7 (-56.3%, p<0.002) and their overall duration shortened from 24.3+/-7.0 to 10.6+/-3.9 min (+56.3%, p<0.02). Analysis of heart rate variability revealed significant augmentation of SDNN in 77.8% of patients (from 130.0+/-6.9 to 145+/-8.1, p<0.05). Severity and extent of myocardial perfusion defects decreased in 87.5% of patients by 24,2% (from 476.1+/-78.5, p<0.01) and 20.3% (from 19.7+/-2.4 to 15.7+/-2.0, p<0.01), respectively. CONCLUSION: The use of trimetazidine as complimentary therapy to nitrates and beta-blockers in patients was associated with additional antianginal and antiischemic effects and improvement of myocardial perfusion.