Post-necrotic left ventricular dysfunction in Diabetes Mellitus: effects of trimetazidine

ABSTRACT

The Index of Myocardial Performance [IMP] in 149 non-diabetic [group I] and 151 diabetic [group II] subjects who were treated for acute myocardial infarction was evaluated using two-dimensional Doppler echocardiography. Isovolumetric Contraction Time [ICT], Isovolumetric Relaxation Time [IRT] and Ejection Time [ET] were also measured. All patients in both groups received conventional, anti-ischaemic therapy [nitrates, ACE-inhibitors, and antiplatelet drug]. In addition, 74 patients in group II [subgroup IIa] received an oral dose of 20 mg of trimetazidine, three times daily. The remaining 77 diabetics in group II were treated with conventional drugs alone [subgroup IIb]. All diabetic patients [group II] also received an anti-diabetic [oral drug or insulin] treatment to keep their diabetes under control. Twelve months after the experiment, IMP was significantly [p<0.001] higher in diabetic patients [0.55 +/- 0.05] compared to non-diabetic controls [0.49 +/- 0.04]. IRT was similar in both groups [81 +/- 15 ms vs 83 +/- 12 ms] and ET [275 +/- 27 ms vs 295 +/- 29 ms] was decreased in diabetics compared to the control group. The one-year follow-up showed a significant decrease in IMP in patients treated with trimetazidine [subgroup IIa] compared to those treated with conventional drugs [subgroup IIb alone]. IRT values were lower in sub-group IIa compared to that of subgroup IIb. ICT returned towards the normal limits in both subgroups. Finally, ET decreased in subgroup IIa but increased in subgroup IIb compared to values obtained at the onset of treatment. In conclusion, trimetazidine when added to the conventional, anti-ischaemic therapy, seems to induce a more evident attenuation of post-AMI left ventricular dysfunction compared to those not given the drug