From recurrent ischemia to ischemic heart failure: new data on trimetazidine

Over recent years, the management of chronic coronary disease has improved markedly as a result of the increased use of surgical and percutaneous revascularization procedures. However, the prevalence of recurrent ischemia, together with the growing population of individuals surviving acute coronary syndromes but with serious myocardial damage, increases the prevalence of ischemic left ventricular cardiomyopathy and heart failure. The management of heart failure is currently based on the use of angiotensin converting enzyme inhibitors, b-adrenolytic agents and aldosterone inhibitors, but cardioprotective metabolic intervention is an interesting novel approach. Trimetazidine, an antiischemic metabolic agent, reduces fatty acid b-oxidation by selective inhibition of 3-ketoacyl coenzyme A thiolase activity, which can decrease the consequences of recurring ischemia, facilitating the maintenance of myocardial function and enhancing left ventricular performance. This paper reviews the recent data regarding the therapeutic effects of trimetazidine in various populations with left ventricular dysfunction. Heart Metab. 2006;31:22–26.