Clinical efficacy of combination therapy with trimetazidine and angiotensin converting enzyme inhibitors in patients with hypertension and ischemic heart disease associated with type II diabetes

Aim. To assess in a randomized open study effect of 12-15 week use of angiotensin converting enzyme inhibitors (ACEI) with and without trimetazidine on myocardial perfusion reserve in patients with ischemic heart disease (IHD) and/or hypertension associated with type II diabetes. Material. Patients (n=69) receiving long term ACEI therapy with transient myocardial perfusion defects during dipyridamole stress test. Methods. Control patients (n=29, including 15 with IHD) continued to receive an ACEI, while in trimetazidine group (n=40, including 21 IHD patients) trimetazidine (60 mg/day) was added to ACEL Single photon emission computer tomography with (199)Thallium Chloride was used for measurement of myocardial perfusion reserve. Changes of physical working capacity, intracardiac hemodynamics and glycemia were studied only in trimetazidine group. Results and conclusions. Significant 52% (mean) decrease (32.5% in IHD patients) of perfusion defects and acceleration on total clearance of Tl-199 were registered in trimetazidine group while no considerable changes of myocardial perfusion were revealed in control group. Most substantial changes of myocardial blood flow reserve occurred in patients with moderate alterations of left ventricular diastolic filling, and among MID patients - in those without cardiac dilatation and pronounced diastolic left ventricular dysfunction. Significant increase (45.9 and 23.9% in patients with and without IHD, respectively) of total work performed during bicycle exercise was registered in trimetazidine treated patients. in IHD patients decline of initially elevated intramyocardial tension was also observed.