Effect of trimetazidine on cardiac function and exercise tolerance in hypertension patients with diabetic

doi:10.3785/j.issn.1008-9292.2019.06.08

J Zhejiang Univ (Med Sci)

2019, Vol. 48

Issue (3): 282-288 DOI: 10.3785/j.issn.1008-9292.2019.06.08

Effect of trimetazidine on cardiac function and exercise tolerance in hypertension patients with diabetic

YE Pingxian*(

),YE Pingzhen,HE Jinping

Department of Cardiology, Zhejiang Jinhua Guangfu Hospital, Jinhua 321000, Zhejiang Province, China

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Abstract

Objective: To determine the effect of trimetazidine on cardiac function and exercise tolerance in primary hypertension patients with type 2 diabetic. Methods: In this randomized, double-blind, placebo-controlled prospective study, 60 primary hypertensive patients with diabetic were equally assigned into two groups, patients received trimetazidine (20 mg, 3 times a day) or placebo for 1 year. Echocardiography, cardiopulmonary exercise testing were performed; and the plasma N terminal pro B type natriuretic peptide (NT-ProBNP), hr-CRP, TNF-α, angiotensin Ⅱ and endothelin concentration were determined before and after treatment. Results: In trimetazidine group, the left ventricular mass index, the mitral flow velocity E wave to A wave ratio (E/A), the peak early diastolic velocity (V_E) to late diastolic velocity (V_A) ratio (V_E/V_A) and the peak systolic velocity (Vs) were significantly improved, the plasma NT-ProBNP level was significantly decreased, and the exercise time, metabolic equivalent, maximal oxygen uptake and anaerobic threshold were significantly increased (all P < 0.05); plasma concentration of hr-CRP, TNF-α, angiotensin Ⅱ and endothelin were significantly reduced after trimetazidine treatment, compared with baseline (all P < 0.05) and with placebo (all P < 0.05). There were no significant differences in any of above parameters after treatment in placebo group (all P>0.05). No severe adverse reaction was observed in both groups. Conclusion: For patients with both hypertension and diabetes, trimetazidine can improve cardiac function and increase exercise tolerance.

Key words： Trimetazidine/therapeutic use Hypertension/complications Hypertension/drug therapy Diabetes complications/drug therapy Ventricular function, left Diastole Exercise tolerance Randomized controlled trial

Received: 10 January 2019 Published: 04 September 2019

CLC:

R544

Corresponding Authors: YE Pingxian E-mail: yepingxian@qq.com

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Cite this article:

YE Pingxian, YE Pingzhen, HE Jinping. Effect of trimetazidine on cardiac function and exercise tolerance in hypertension patients with diabetic. J Zhejiang Univ (Med Sci), 2019, 48(3): 282-288.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.06.08 OR http://www.zjujournals.com/med/Y2019/V48/I3/282

曲美他嗪对高血压合并糖尿病患者心功能及运动耐量的影响

目的: 观察曲美他嗪治疗对高血压合并2型糖尿病患者心功能及运动耐量的影响。方法: 采用随机、双盲、安慰剂对照的前瞻性研究方法。选择高血压合并2型糖尿病患者60例，随机分成曲美他嗪治疗组和对照组各30例。两组均给予规范降压、降糖、抗血小板及他汀类药物降脂治疗，治疗组在此基础上口服盐酸曲美他嗪治疗，对照组使用安慰剂治疗，疗程为1年。两组治疗前后均行心脏超声心动图检查、运动心肺功能测定、血浆氨基端脑钠肽前体（NT-ProBNP）浓度测定，并测定其超敏C反应蛋白、TNF-α、血管紧张素Ⅱ、血浆内皮素等血浆细胞因子水平。结果: 曲美他嗪治疗组治疗后，左心室质量指数、二尖瓣血流频谱E峰与A峰比值、二尖瓣环运动舒张早期峰速度与舒张晚期峰速度比值及收缩期峰值速度均明显改善，与治疗前及对照组治疗后差异均具有统计学意义（均P < 0.05）；NT-ProBNP下降，与治疗前及对照组治疗后差异均具有统计学意义（均P < 0.05）；运动耐量改善，表现为运动时间延长，运动当量、最大摄氧量、无氧阈增大，各指标与治疗前及对照组治疗后差异均有统计学意义（均P < 0.05）；治疗组超敏C反应蛋白、血浆内皮素、TNF-α、血管紧张素Ⅱ下降，相比治疗前及对照组治疗后差异均有统计学意义（均P < 0.05）。对照组未见上述指标在治疗前后有明显差异（均P>0.05）。两组均未发生严重不良反应。结论: 曲美他嗪能有效改善高血压合并糖尿病患者的心功能，提高运动耐量。

关键词： 曲美他嗪/治疗应用, 高血压/并发症, 高血压/药物疗法, 糖尿病并发症/药物疗法, 心室功能, 左, 心舒期, 运动耐量, 随机对照试验

Tab 1 Baseline characteristics of treatment group and control group

Tab 2 Results of cardiac function examination before and after treatment in treatment group and control group

Tab 3 Exercise tolerance between treatment group and control group ($\bar x \pm s$)

Tab 4 Inflammation and vascular endothelial function between treatment group and control group

Tab 5 Blood lipid metabolism and glucose measurements between treatment group and control group


[1]	MARTINS-MENDES D , MONTEIRO-SOARES M , BOYKO E J et al. The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk[J]. J Diabetes Complications, 2014, 28 (5): 632- 638 doi: 10.1016/j.jdiacomp.2014.04.011

[2]	VITALE C , SPOLETINI I , MALORNI W et al. Efficacy of trimetazidine on functional capacity in symptomatic patients with stable exertional angina——the VASCO-angina study[J]. Int J Cardiol, 2013, 168 (2): 1078- 1081 doi: 10.1016/j.ijcard.2012.11.001

[3]	BUCCI M , BORRA R , N?GREN K et al. Trimetazidine reduces endogenous free fatty acid oxidation and improves myocardial efficiency in obese humans[J]. Cardiovasc Ther, 2012, 30 (6): 333- 341 doi: 10.1111/j.1755-5922.2011.00275.x

[4]	AMBER K I , HADI N R , MUHAMMAD-BAQIR B M et al. Trimetazidine attenuates the acute inflammatory response induced by Novolimus eluting bioresorbable coronary scaffold implantation[J]. Int J Cardiol, 2016, 220 (1): 514- 519

[5]	KOTA S K , KOTA S K , JAMMULA S et al. Effect of diabetes on alteration of metabolism in cardiac myocytes:therapeutic implications[J]. Diabetes Technol Ther, 2011, 13 (11): 1155- 1160 doi: 10.1089/dia.2011.0120

[6]	中国高血压防治指南修订委员会 . 中国高血压防治指南2010[J]. 中华高血压杂志, 2011, 19 (8): 701- 742 Writing Group of 2010 Chinese Guidelines for the Management of Hypertension . 2010 Chinese guidelines for the management of hypertension[J]. Chinese Journal of Hypertension, 2011, 19 (8): 701- 742

[7]	NATHAN D M , BUSE J B , DAVIDSON M B et al. American Diabetes Association; European Association for Diabetes Medical management of hyperglycemia in type 2 diabetes:a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes[J]. Diabetes Care, 2009, 32 (1): 193- 203 doi: 10.2337/dc08-9025

[8]	ZHOU X, CHEN J. Is treatment with trimetazidine beneficial in patients with chronic heart failure?[J/OL]. PLoS One, 2014, 9(5): e94660.

[9]	LOPATIN Y M , ROSANO G M , FRAGASSO G et al. Rationale and benefits of trimetazidine by acting on cardiac metabolism in heart failure[J]. Int J Cardiol, 2016, 203 (15): 909- 915

[10]	HU B , LI W , XU T et al. Evaluation of trimetazidine in angina pectoris by echocardiography and radionuclide angiography:a meta-analysis of randomized, controlled trials[J]. Clin Cardiol, 2011, 34 (6): 395- 400 doi: 10.1002/clc.20888

[11]	LIU Y C , LI L , SU Q et al. Trimetazidine pretreatment inhibits myocardial apoptosis and improves cardiac function in a Swine model of coronary microembolization[J]. Cardiology, 2015, 130 (2): 130- 136 doi: 10.1159/000369246

[12]	WEI J , XU H , SHI L et al. Trimetazidine protects cardiomyocytes against hypoxia-induced injury through ameliorates calcium homeostasis[J]. Chem Biol Interact, 2015, 236 (5): 47- 56

[13]	LIU Z , CHEN J M , HUANG H et al. The protective effect of trimetazidine on myocardial ischemia/reperfusion injury through activating AMPK and ERK signaling pathway[J]. Metabolism, 2016, 65 (3): 122- 130 doi: 10.1016/j.metabol.2015.10.022

[14]	HAO J , DU H , LIW W et al. Effects of atorvastatin combined with trimetazidine on myocardial injury and inflammatory mediator in unstable angina patients during perioperative of percutaneous coronary intervention[J]. Eur Rev Med Pharmacol Sci, 2015, 19 (23): 4642- 4646

[15]	SHEHATA M . Impact of trimetazidine on incidence of myocardial injury and contrast-induced nephropathy in diabetic patients with renal dysfunction undergoing elective percutaneous coronary intervention[J]. Am J Cardiol, 2014, 114 (3): 389- 394 doi: 10.1016/j.amjcard.2014.04.052

[16]	SU Q , LI L , ZHAO J et al. Effects of trimetazidine on PDCD4/NF-κB/TNF-α pathway in coronary microembolization[J]. Cell Physiol Biochem, 2017, 42 (2): 753- 760 doi: 10.1159/000478067

[17]	WILLIAMS B , MANCIA G , SPIERING W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension[J]. Eur Heart J, 2018, 39 (33): 3021- 3104 doi: 10.1093/eurheartj/ehy339

[18]	中华医学会糖尿病学分会 . 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10 (1): 4- 67 Chinese Diabetes Society . 2017 Guidelines for the prevention and treatment of type 2 diabetes in China[J]. Chinese Journal of Diabetes Mellitus, 2018, 10 (1): 4- 67 doi: 10.3760/cma.j.issn.1674-5809.2018.01.003

[19]	傅路红, 叶萍仙, 孙志凌 et al. 高血压及左心室肥厚患者的心肺运动功能[J]. 中华心血管病杂志, 2008, 36 (8): 718- 721 FU Luhong , YE Pingxian , SUN Zhiling et al. Reduced cardiopulmonary exercise capacity in patients with essential hypertension:impact of left ventricular hypertrophy[J]. Chinese Journal of Cardiology, 2008, 36 (8): 718- 721 doi: 10.3321/j.issn:0253-3758.2008.08.011

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