The effectiveness of trimetazidine in the treatment of CHF patients with cardiopulmonary pathology

Introdiction. The article  highlights  the  importance of optimizing  the  treatment of chronic heart  failure  (CHF) in patients with comorbid cardiopulmonary pathology, namely ischemic heart  disease  (CHD) in combination with chronic obstructive pulmonary disease (COPD). The results of our own research on the evaluation of the clinical efficacy of trimetazidine inclusion in the complex therapy of comorbid pathology  are presented.

Objective. To study the clinical efficacy of trimetazidine as part of the complex therapy  of patients with ischemic heart  failure in combination with COPD.

Materials  and  methods.  60  patients with  CHF II-III FC, left  ventricular  ejection  fraction  (LVEF) <45% were  studied  against the background  of postinfarction cardiosclerosis and COPD of 2–3  degrees of airflow restriction. The patients were divided into 2 groups:  1st  (30 patients)  took trimetazidine; 2nd  (30 patients)  received  therapy  without  the  addition  of trimetazidine. The dynamics of: clinical condition  with the use of SHOCK, FC CHF, test with 6-min. walking, quality of life (MLHFQ, SGRQ), indicators of 24-bifunctional monitoring, TTE, spirometry, platelet aggregation and blood viscosity.

Results and conclusion. The use of trimetazidine as part of therapy led to an improvement in the clinical course of the disease, significantly increased exercise  tolerance. The number  and duration  of ischemia  episodes decreased by 34 and 39% (p < 0.05). The number of angina attacks per week and the need for nitroglycerin  decreased by 65% and 42% (p < 0.05), respectively. There was an improvement in intracardiac  and  peripheral hemodynamics.  Thus, LV LV increased by 21%, pulmonary  artery pressure decreased by 18%, the indicators  of LVD, platelet aggregation and blood rheology improved. There was a more positive dynamics of lipid peroxidation and antioxidant system indicators  compared  to the control group.

1. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) andacute decompensated(ADHF). Diagnostic, prevention and treatment. Kardiologiya. 2018;58(6s):8–158. (In Russ.) https://doi.org/10.18087/cardio.2475.

2. Avdeev S.N., Aysanov Z.R., Belevsky A.S. Clinical guidelines of Russian respiratory society. Algorithm for the management of patient with COPD. Therapy. 2017;4(14):102–106. (In Russ.) Available at: https://therapy-journal.ru/ru/archive/article/35046.

3. Agusti A., Vogelmeier C., Papi A., Beasley R., Pavord I., Celli B.R. et al. GOLD 2021. Global Strategy for the Diagnosis, Managament and Prevention of COPD, 2021. Available at: https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf.

4. Campo G., Pavasini R., Malagù M., Mascetti S., Biscaglia S., Ceconi C. et al. Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovasc Drugs Ther. 2015;29(2):147–157. https://doi.org/10.1007/s10557-014-6569-y.

5. O’Kelly N., Robertson W., Smith J., Dexter J., Carroll-Hawkins C., Ghosh S. Short-term outcomes in heart failure patients with chronic obstructive pulmonary disease in the community. World J Cardiol. 2012;4(3):66–71. https://doi.org/10.4330/wjc.v4.i3.66.

6. Selvaraj C.L., Gurm H.S., Gupta R., Ellis S.G., Bhatt D.L. Chronic obstructive pulmonary disease as a predictor of mortality in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2005;96(6):756–759. https://doi.org/10.1016/j.amjcard.2005.05.016.

7. Wouters E.F., Creutzberg E.C., Schols A.M. Systemic effects in COPD. Chest. 2002;121(5 Suppl.):127S–130S. https://doi.org/10.1378/chest.121.5_suppl.127s.

8. Grigorieva N.Yu., Kuznetsov A.N., Sharabrin E.G. Role of chronic obstructive pulmonary disease in development of the cardiovascular continuum. Russian Heart Journal. 2012;2(64):120–122. (In Russ.) Available at: https://elibrary.ru/item.asp?id=18419006.

9. Evdokimov V.V., Evdokimova A.G., Fedorova T.V., Tebloev K.I. Features of structural and functional changes in the cardiovascularsystem and their correction in patients with chronic heart failurein combination with cardiopulmonary pathology. Medical Alphabet. 2016;16(2):46–50. (In Russ.) Available at: https://elibrary.ru/item.asp?id=26733479.

10. Aisanov Z.R., Chuchalin A.G., Kalmanova E.N. Chronic obstructive pulmonary disease and cardiovascular comorbidity. Kardiologiya. 2019;59(8S):24–36. (In Russ.) https://doi.org/10.18087/cardio.2572.

11. Evdokimov V.V., Evdokimova A.G., Yuschuk E.N. Characteristics of clinical and functional changes in patients with ischemic CHF with concomitant COPD. RMJ. 2019;(12):8–13. (In Russ.) Available at: https://www.rmj.ru/articles/kardiologiya/Osobennosti_kliniko-funkcionalynyh_izmeneniy_u_bolynyh_s_HSN_ishemicheskogo_geneza_v_sochetanii_s_HOBL.

12. Ostroumova O.D., Kochetkov A.I. Chronic obstructive pulmonary disease and comorbid cardiovascular disease: in the context of guidelines. Consilium Medicum. 2018;20(1):54–61. (In Russ.) https://doi.org/10.26442/2075-1753_2018.1.54-61.

13. Larina V.N. Multisystem effect of citoprotection. Consilium Medicum. 2021;23(1):93–98. (In Russ.) https://doi.org/10.26442/20751753.2021.1.200732.

14. Sizova Z.M., Vladimirov S.K. Modern peculiarities of myocardial cytoprotection in therapy of ishemic heart disease patients. Meditsinskiy Sovet. 2016;(13):38–43. (In Russ.) https://doi.org/10.21518/2079-701X-2016-13-38-43.

15. Aronov D.M. Expert consensus on the role and place of a myocardial cytoprotector, trimetazidine (Preductal MB), in treatment of patients with chronic forms of ischemic heart disease. Russian Heart Journal. 2015;14(4):256–260. (In Russ.) https://doi.org/10.18087/rhj.2015.4.2147.

16. Evdokimov V.V., Yushchuk E.N., Evdokimova A.G., Stryuk R.I. Efficacy and safety of long-term use of prolonged bronchodilators in patients with cardiopulmonary pathology and chronic heart failure. Consilium Medicum. 2019;21(5):78–83. (In Russ.) https://doi.org/10.26442/20751753.2019.5.190433.

17. Bonten T.N., Plaizier C.E., Snoep J.J., Stijnen T., Dekkers O.M., van der Bom J.G. Effect of β-blockers on platelet aggregation: a systematic review and meta-analysis. Br J Clin Pharmacol. 2014;78(5):940–949. https://doi.org/10.1111/bcp.12404.