Tratamentul cardiac metabolic: efectele trimetazidinei

Abstract

Background: The heart affection at is associated with energy deficiency due to oxygen dearth which alters a lot of cardiac functions, most important of them being ion pump working, myocardial contractility and relaxation. Attempting of energy synthesis improvement is an important tenet of cardiac metabolic therapy leading to clinical and functional benefits. Nowadays trimetazidine (TMZ) is admittedly recognized as a reliable remedy providing energetic gain, thereby, inhibition of mitochondrial long chain 3-ketoacyl Co-enzyme A thiolase involved in free fatty acids oxidation, shifting energy synthesis toward glucose oxidation which needs lesser oxygen consumption by up to 25%. Material and methods: This article is aimed at the revealing of TMZ effects on patients with stable angina pectoris, ischemia-reperfusion syndrome and chronic heart failure inclusively based on evidences of A level (data of randomized trials and meta-analyses). Added to standard anti-ischemic therapy, TMZ (60 or 70 mg/day) has led to a significant increase of time and volume of physical effort, period of ST decline and angina appearing, as well as reducing of angina episodes per day and anti-anginal remedies’ dosage. Results: The chronic heart failure therapy supplementation by TMZ induced a more conspicuous decrease of NYHA class, preserved ventricular end-systolic and end-diastolic volumes, Tei index value, B-type natriuretic peptide blood level, while ejection fraction raised higher even in patients with diabetes mellitus. Conclusions: It is important to emphasize the TMZ capacity to blunt the oxidative stress activity, nonspecific inflammation response and cell apoptosis during myocardial ischemia-reperfusion, to improve the function of affected and hibernating myocardium, to prevent or attenuate the cardiovascular sequels after coronary revascularization by artery bypass surgery or angioplasty with stent implantation.