PDF(Pubmed)
Abstract：
BACKGROUND: Despite maximal treatment, heart failure (HF) remains a major clinical challenge. Besides neurohormonal overactivation, myocardial energy homoeostasis is also impaired in HF. Trimetazidine has the potential to restore myocardial energy status by inhibiting fatty acid oxidation, concomitantly enhancing glucose oxidation. Trimetazidine is an interesting adjunct treatment, for it is safe, easy to use and comes at a low cost.
OBJECTIVE: We conducted a systematic review to evaluate all available clinical evidence on trimetazidine in HF. We searched Medline/PubMed, Embase, Cochrane CENTRAL and ClinicalTrials.gov to identify relevant studies.
METHODS: Out of 213 records, we included 28 studies in the meta-analysis (containing 2552 unique patients), which almost exclusively randomised patients with HF with reduced ejection fraction (HFrEF). The studies were relatively small (median study size: N=58) and of short duration (mean follow-up: 6 months), with the majority (68%) being open label.
RESULTS: Trimetazidine in HFrEF was found to significantly reduce cardiovascular mortality (OR 0.33, 95% CI 0.21 to 0.53) and HF hospitalisations (OR 0.42, 95% CI 0.29 to 0.60). In addition, trimetazidine improved (New York Heart Association) functional class (mean difference: -0.44 (95% CI -0.49 to -0.39), 6 min walk distance (mean difference: +109 m (95% CI 105 to 114 m) and quality of life (standardised mean difference: +0.52 (95% CI 0.32 to 0.71). A similar pattern of effects was observed for both ischaemic and non-ischaemic cardiomyopathy.
CONCLUSIONS: Current evidence supports the potential role of trimetazidine in HFrEF, but this is based on multiple smaller trials of varying quality in study design. We recommend a large pragmatic randomised clinical trial to establish the definitive role of trimetazidine in the management of HFrEF.
OBJECTIVE: We conducted a systematic review to evaluate all available clinical evidence on trimetazidine in HF. We searched Medline/PubMed, Embase, Cochrane CENTRAL and ClinicalTrials.gov to identify relevant studies.
METHODS: Out of 213 records, we included 28 studies in the meta-analysis (containing 2552 unique patients), which almost exclusively randomised patients with HF with reduced ejection fraction (HFrEF). The studies were relatively small (median study size: N=58) and of short duration (mean follow-up: 6 months), with the majority (68%) being open label.
RESULTS: Trimetazidine in HFrEF was found to significantly reduce cardiovascular mortality (OR 0.33, 95% CI 0.21 to 0.53) and HF hospitalisations (OR 0.42, 95% CI 0.29 to 0.60). In addition, trimetazidine improved (New York Heart Association) functional class (mean difference: -0.44 (95% CI -0.49 to -0.39), 6 min walk distance (mean difference: +109 m (95% CI 105 to 114 m) and quality of life (standardised mean difference: +0.52 (95% CI 0.32 to 0.71). A similar pattern of effects was observed for both ischaemic and non-ischaemic cardiomyopathy.
CONCLUSIONS: Current evidence supports the potential role of trimetazidine in HFrEF, but this is based on multiple smaller trials of varying quality in study design. We recommend a large pragmatic randomised clinical trial to establish the definitive role of trimetazidine in the management of HFrEF.
摘要：
背景：尽管进行了最大程度的治疗，心力衰竭（HF）仍然是一个主要的临床挑战。除了神经激素过度激活,在HF中,心肌能量均稳态也受损。曲美他嗪有可能通过抑制脂肪酸氧化来恢复心肌能量状态，同时增强葡萄糖氧化。曲美他嗪是一种有趣的辅助治疗，因为它是安全的，易于使用，成本低。
目的：我们进行了系统评价，以评估曲美他嗪治疗HF的所有可用临床证据。我们搜索了Medline/PubMed,Embase,CochraneCENTRAL和ClinicalTrials.gov确定相关研究。
方法：在213条记录中，我们在荟萃分析中纳入了28项研究（包含2552名独特患者），几乎完全随机分配了射血分数降低（HFrEF）的HF患者。研究相对较小（中位研究规模：N=58），持续时间短（平均随访：6个月），大多数（68％）是开放标签。
结果：发现曲美他嗪在HFrEF中可显著降低心血管死亡率（OR0.33，95％CI0.21至0.53）和HF住院率（OR0.42，95％CI0.29至0.60）。此外,曲美他嗪改善（纽约心脏协会）功能等级（平均差异：-0.44（95％CI-0.49至-0.39），6分钟步行距离（平均差：+109m（95%CI105-114m）和生活质量（标准化平均差：+0.52（95%CI0.32-0.71））。对于缺血性和非缺血性心肌病均观察到相似的作用模式。
结论：目前的证据支持曲美他嗪在HFrEF中的潜在作用，但这是基于多项较小的试验，这些试验的质量各不相同。我们建议进行一项大型实用随机临床试验，以确定曲美他嗪在HFrEF治疗中的明确作用。
目的：我们进行了系统评价，以评估曲美他嗪治疗HF的所有可用临床证据。我们搜索了Medline/PubMed,Embase,CochraneCENTRAL和ClinicalTrials.gov确定相关研究。
方法：在213条记录中，我们在荟萃分析中纳入了28项研究（包含2552名独特患者），几乎完全随机分配了射血分数降低（HFrEF）的HF患者。研究相对较小（中位研究规模：N=58），持续时间短（平均随访：6个月），大多数（68％）是开放标签。
结果：发现曲美他嗪在HFrEF中可显著降低心血管死亡率（OR0.33，95％CI0.21至0.53）和HF住院率（OR0.42，95％CI0.29至0.60）。此外,曲美他嗪改善（纽约心脏协会）功能等级（平均差异：-0.44（95％CI-0.49至-0.39），6分钟步行距离（平均差：+109m（95%CI105-114m）和生活质量（标准化平均差：+0.52（95%CI0.32-0.71））。对于缺血性和非缺血性心肌病均观察到相似的作用模式。
结论：目前的证据支持曲美他嗪在HFrEF中的潜在作用，但这是基于多项较小的试验，这些试验的质量各不相同。我们建议进行一项大型实用随机临床试验，以确定曲美他嗪在HFrEF治疗中的明确作用。
