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.
Marzilli M, et al. J Am Coll Cardiol. 2012;60:951-956.
Myocardial ischemia is multifactorial
Marzilli M, et al. J Am Coll Cardiol 2012;60:951–6.
Ischemia is an energy deficiency
Increased energy in the ischemic heart
P=0.04
1,00
1,50
2,00P
cr/A
TP
rat
io
placebo TMZ
+33%
Fragasso G, et al. Eur Heart J. 2006;27:942-948.
Cellular energy balance
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.
Time to 1-mm ST depression
Trimetazidine
Placebo
Time to onset of angina
Angina attacks/week (n) Nitrate use / week (n)
n=426Stable angina patientsAll on metoprolol(50 mg/day)
Szwed H, et al. TRIMPOL II Eur Heart J. 2001;22:2367-2374.
P<0.01
NS
W0 W12
450
400
350
300
Tim
e (
s)
5
2
1
0
4
3
An
gin
a a
ttacks
W0 W12
NS P<0.01
W0 W12
Tim
e (
s)
NS
P<0.01500
400
350
300
450
4
2
1
0
3
Mean
n
itra
te u
se /
week (
n)
W0 W12
NS P<0.01
Proven antianginal efficacy with -blockers
Proven antianginal efficacy with -blockers
Michaelides AP, et al. Clin Drug Invest. 1997;13:8-14.
n=53Stable angina patients uncontrolled withPropranolol 40 mg/day
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.