Trimetazidine in Heart Failure Management

Current Guideline Recommendations for Heart Failure

The European Society of Cardiology recommends ACE inhibitors as the established first-line therapy for patients with reduced left ventricular systolic function (ejection fraction <40-45%), with or without symptoms 3, 4
The European Society of Cardiology strongly recommends beta-blockers for patients with left ventricular dysfunction, particularly when heart failure coexists with angina 2, 5
The European Society of Cardiology considers diuretics essential for symptomatic treatment when fluid overload is present 3

Trimetazidine is a metabolic modulator that inhibits mitochondrial 3-ketoacyl-CoA thiolase, increasing glucose metabolism and improving metabolic efficiency of ischemic myocytes, according to the American College of Cardiology 1, 6
The American College of Cardiology notes that trimetazidine does not exert hemodynamic effects but improves the metabolic efficiency of the heart 1
Treatment with trimetazidine for 3 months has been shown to increase myocardial levels of high-energy phosphates by 33% in patients with heart failure, as reported by the American Heart Association 6

For patients with heart failure and angina, the European Society of Cardiology recommends optimizing existing therapy, especially beta-blockade, considering coronary revascularization, adding long-acting nitrates, and considering trimetazidine only if the above measures are not successful 7, 8

The American College of Cardiology notes that trimetazidine is generally well-tolerated with mild adverse effects (gastrointestinal disturbances, minor headaches) 1, 6
The European Society of Cardiology contraindicates trimetazidine in patients with Parkinson's disease, parkinsonism, and other movement disorders, as well as severe renal impairment (creatinine clearance <30 ml/min) 1, 9