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Benefits of adding a energetic agent to
-blockers to achieve optimal reduction
of angina.
Review of the main studies
Is coronary obstruction the only player in
ischemic heart disease?
Sambuceti G. Eur J Nucl Med Mol Imaging. 2005;32:385-388.
Is coronary obstruction the only player in
ischemic heart disease?
Cheng VY, et al. Circulation. 2011;124:2423-2432.
Myocardial ischemia is multifactorial
Marzilli M, et al. J Am Coll Cardiol. 2012;60:951-956.
Ischemia is an energy deficiency
Marzilli M, et al. J Am Coll Cardiol 2012;60:951–6.
Increased energy in the ischemic heart
+33%
P c r/A T P ra tio
2 ,0 0
P = 0 .0 4
1 ,5 0
1 ,0 0
p la c e b o
Fragasso G, et al. Eur Heart J. 2006;27:942-948.
TM Z
Act on both sides of the cellular energy balance
To protect the cells from ischemia, the energy supply needs to
remain greater than the energy demand.
Cellular energy balance
Proven antianginal efficacy with -blockers
Time to 1-mm ST depression
450
Time to onset of angina
500
P<0.01
P<0.01
Time (s)
Time (s)
450
400
NS
350
400
n=426
Stable angina patients
All on metoprolol
(50 mg/day)
NS
350
300
W0
W12
300
5
NS
P<0.01
Angina attacks
4
3
2
1
0
W0
W12
Nitrate use / week (n)
Mean nitrate use / week (n)
Angina attacks/week (n)
W0
W12
Szwed H, et al. TRIMPOL II Eur Heart J. 2001;22:2367-2374.
4
NS
P<0.01
3
2
1
0
W0
W12
Trimetazidine
Placebo
Proven antianginal efficacy with -blockers
n=53
Stable angina patients
uncontrolled with
Propranolol 40 mg/day
Michaelides AP, et al. Clin Drug Invest. 1997;13:8-14.
Proven antianginal efficacy with -blockers
Nesukay E, et al. ESC 2013. Abstract 86728.
Conclusions
Chronic ischemic heart disease (IHD) is still a significant
clinical burden
IHD results from a number of mechanisms
To ensure optimal management of IHD on top of -blockers, it
is essential to address the energetic origin of ischemia
Trimetazidine MR is an effective drug to use in combination
with β-blockers to relieve angina effectively.