Assessment of Left Ventricular Functions Before and After Triemtazidine in Diabetic Ischemic Cardiomyopathy

Abstract

Ishcemia initially induces reversible metabolic, - mechanical and electrocardiographic (ECG) changes in the heart. Metabolic changes in the ischemic myocardium arise from the decrease in glucose oxidation. Pharmacological manipulation of cellular energy metabolism, appears to be a rational approach and Trimetazidine (TMZ) is a representative of a new class of metabolic agents with a myocardial anti­ ischemic effect aclJ.ieved independently of changes in the oxygen supply to demand ratio. Diabetic patients ,fuay gain a specific benefit as metabolic alterations consequent to DM are closely linked to the accumulation of various acyl carnitine and co-enzyme derivatives. The •purpose of the. present .study is to determine. the effect of TMZ on cardiac function in diabetic patients with IHD. To achieve this purpose-we studied 21 diabetic patients (pts) with ischemic cardiomyopathy (CM) (19M, 2 F mean age 57.5±4.2). IHD was diagnosed by clinical history in all pts, coronary angiography in 5 pts,- history of CABG in 1 pt & echocardiographic evidence of regional wall m.:otion abnormalities in all pts. Ten pts received TMZ (9 M, 1 F, mean age 56±7.2) whereas a control group of 11 pts (10M, 1 F, mean age. 59.4±8.9) received only conventional treatment without TMZ. Following clinical evaluation, all pts were subjected to resting ECG & . 2D . echocardiography. TMZ was received at a dose of20 mg tid, by group l pts. Low dose dobutamine stress echocardiography (DSE) was performed on admission & after 60 days in both groups. DSE was done under••continuous ECG monitoring, dobutmame was infused at an incremental regimen of 5 mictKg/min every -3 minutes until -a maximum dose of 20 mic!Kg/min. Beside measurementS of HR. & BP., Echo parameters as LVEDD, LVESD, FS% EF'/o, regional wall motion score index (RWMIS) were taken at rest & after DSE, both before & after 60 days of TMZ treatment. • •